Waking up to see facial paralysis in the mirror is shocking and scary, especially if you otherwise feel normal. A likely cause is Bell’s palsy, and for most people, it’s a temporary problem that improves within a few weeks.

What is Bell’s palsy? Who does it affect?

Bell’s palsy is a neurological disorder that causes temporary paralysis, or palsy, of facial muscles on one side of the face in most cases. It results from a dysfunction of a facial nerve known as cranial nerve VII, which controls muscles responsible for things like closing the eye and smiling.

Bell’s palsy is the most common cause of facial paralysis. It affects about 40,000 people in the United States every year, according to the National Institute of Neurological Disorders and Stroke. It can occur at any age, although it is more common in people age 15 to 45. Diabetes, high blood pressure, obesity, pregnancy, preeclampsia, and upper respiratory illnesses can increase one’s risk for Bell’s palsy.

What are the symptoms of Bell’s palsy?

While symptoms and severity can vary from person to person, the most common symptom of Bell’s palsy is sudden weakness on one side of the face. Weakness or paralysis can occur within hours to several days. In addition to facial drooping, symptoms may include:

• Drooling or difficulty swallowing
• Inability to close the eye completely
• Excessive tear production
• Headache
• Pain around the jaw or ears
• Increased sensitivity to sound
• Altered sense of taste

The cause of Bell’s palsy is unknown. It’s believed to be caused by a viral infection that causes inflammation of cranial nerve VII. Research suggests that strains on the immune system, such as minor illnesses or autoimmune diseases, are possible triggers.

When to call a doctor

Contact your provider right away if you experience any paralysis symptoms. Bell’s palsy is not caused by a stroke, but the two conditions share some symptoms.

“The most important aspect of Bell’s palsy treatment is a timely presentation,” says Summit Health otolaryngologist Amishav Bresler, MD. “Usually, we like to start treatment within 72 hours of symptoms starting.”

While waiting to see your provider, Dr. Bresler says eye protection is key. “You may not be able to close your eye at night. This may lead to damage from rubbing it on your pillow and the eye drying out from exposure,” he explains. He recommends lubricating eye drops and taping the affected eye closed at night. Wearing an eye patch or goggles during the day can provide further protection from irritants and injury.

Diagnosis and treatment

There isn’t a specific test to diagnose Bell’s palsy. Rather, your provider will make a diagnosis based on a physical exam and by ruling out other conditions that may be causing your symptoms.

Additional tests aren’t always necessary, but if the cause of your symptoms isn’t clear, your provider may request lab tests or imaging to rule out:

• Stroke
• Tumor
• Guillain-Barré syndrome, a rare neurological disorder
• Other rare autoimmune diseases, including sarcoidosis and Sjogren’s syndrome
• Infections such as:
  • HIV (human immunodeficiency virus)
  • Lyme disease
  • Middle ear infection (otitis media)
  • Shingles (herpes zoster)

“Lyme disease is more common than you think,” says Dr. Bresler, and urges checking for ticks after being outdoors. “[Lyme disease] is a cause of facial paralysis that can be prevented by good skin exams after hiking,” he continues.

Bell’s palsy can improve on its own. Still, your provider may recommend one or more of the following to help with symptoms or speed recovery.

• Oral steroids, such as prednisone, reduce nerve swelling.
• Aspirin, acetaminophen, or ibuprofen may help relieve pain.
• Antiviral drugs, such as acyclovir or valacyclovir, are sometimes combined with oral steroids, although it’s unclear how much they benefit.
• Other therapies such as physical therapy, facial massage, electrical stimulation, or acupuncture are options. However, Dr. Bresler cautions results may be “underwhelming.”

“Overall, recovery from Bell’s palsy is pretty good,” Dr. Bresler says. Symptoms often improve within three weeks, and most people eventually recover fully. “About 70 percent of patients recover in three to six months, and with early steroid treatment, response rates can reach 85 percent,” he says.

Dr. Bresler adds, “That being said, there can be a recurrence of Bell’s in about 10 percent of patients within 10 years.”

While most people recover fully from Bell’s palsy, some are left with residual facial drooping and paralysis. Another complication is the abnormal regrowth of nerve fibers, resulting in a condition called synkinesis.

“Unfortunately, synkinesis can happen – it’s an involuntary contraction of part of the face with the voluntary movement of another,” says Dr. Bresler. “A classic example is the involuntary closing of your eye while smiling.” He says Botox treatment can be helpful in this case.

In addition to synkinesis treatment, Dr. Bresler notes other options for cases where normal function doesn’t fully return:

• Gold weights, which are implanted inside the upper eyelid to help it close and keep the eye protected.
• Brow lift surgery, which corrects brow asymmetry caused by nerve damage.

Recognizing an Emergency

Facial drooping or paralysis should be immediately evaluated by a medical profession to determine whether it is Bell’s palsy or a more serious condition. As with most everything, early diagnosis and treatment increases the chances for a full recovery.