What is Bell's palsy? Symptoms, treatment and recovery

SAN ANTONIO – Six weeks ago, the left side of my smile disappeared. I couldn’t close or blink my left eye.

Nothing on the left side of my face would move, and I was diagnosed with Bell’s palsy the next day.  

I have been amazed by how many people commented on my social media posts about Bell’s palsy, saying they’ve had it, too or know someone who has had it.

“We think that Bell's palsy is caused by a virus -- the same virus that causes cold sores,” said Dr. Christine Burke Taylor, facial plastics reconstructive surgeon and ENT at University Hospital.

“We usually think of it as something that has probably been sitting in your system for a while and it usually gets reactivated by a stressor or by an illness,” Taylor said.

In my case, Bell’s palsy set in a month after I came down with the flu and pneumonia.

The virus causes inflammation near the ear, which presses on the facial nerve, rendering half of the face completely or partially paralyzed.

“We believe that it happens in the part of the facial nerve where the nerve runs through the bone and the skull out towards the face,” Taylor said. “That means that the forehead muscles will be weakened. The eye will have difficulty closing because the muscle that squeezes the eye closed will be affected. Usually, the smile is affected and the mouth may droop.”

Many people have to tape their eye shut to protect it like I did. Damage to the eye is the immediate threat of Bell’s palsy. The rest requires a lot of patience.

“Approximately 70 percent of patients will recover in three to six months. That's the typical course,” Taylor said. “Twenty to thirty percent of patients will have some sort of deficit after that three- to six-month period. It can range from not recovering at all to recovering incompletely with a little bit of weakness.”

If patients don’t recover fully, there are treatments that could help them restore symmetry to the face. That’s important for people to know, Taylor said.

But that’s the long game. Some say physical therapy helps restore facial movement. Others suggest acupuncture.

I’ve even had one doctor tell me patients have said chewing gum helped them. I’ve done all of it.

“We try to do a lot of massaging techniques that are real gentle at first. You know, help you to stretch your face, move it, so we support the healing process,” said Chara Rodriguez, neurologic clinical specialist at the Reeves Rehabilitation Center within University Health System. “A lot of it is just allowing that nerve to be in the best environment to reconnect with the different muscles.”

Rodriguez, who specializes in physical therapy for Bell’s palsy and other conditions affecting movement in the face, said physical therapy helps prevent atrophy in the paralyzed muscles, especially for patients whose recover takes months.

The therapy also aims to create and ultimately restore symmetry in the face.

“At first, we ask you to kind of slow down the uninvolved side so that you have to use them together, so there's not that tendency for the one side, which is stronger, to sort of over-dominate,” she said.

The affected nerve is located near the ear, so Rodriguez said the areas that heal the fastest as that nerve is restored tend to be closest to the ear.

“The two areas that are usually the longest coming back are the forehead and the chin. It makes sense if you think about this is where the injury was,” Rodriguez said. “On some people, that's 12 inches long. And if you think about the nerve healing, its an inch a month or a millimeter a day, kind of like your fingernails grow.”

Rodriguez said the majority of patients are better in six weeks.

There’s some belief that treatments, including physical therapy, do nothing for Bell’s palsy. Statistically, 70 percent of patients recover without any treatment at all.

But Taylor and Rodriguez agree that feeling more in control during recovery can benefit a patient.

“The emotional and psychological impact of a facial nerve paralysis makes you need to do something,” Taylor said. “Doing something, feeling proactive, working with a physical therapist, meeting with the physicians who are going to walk with you through this journey can psychologically make a huge difference. And for me, I think that makes a huge impact in how patients heal overall.”

It is critical, however, to see a doctor to make sure facial paralysis symptoms aren’t caused by a stroke.

Taylor said if the forehead is moving but the rest of the face is not, it is not likely Bell’s palsy.

Doctors usually prescribe Bell’s palsy patients steroid and antiviral medications, which are believed to have the biggest benefit if taken within the first 48 to 72 hours of symptoms.

In my research about Bell’s palsy, conversations with doctors and, yes, frantic Googling during my recovery, I’ve come across a lot of confusion.

Some people fully recover. Some recover but still have lingering symptoms, like synkensis. That’s when the nerve “wires” get crossed after trauma. For example, smiling may cause a person’s eye to close.

Some people are better in just a few weeks. Some take months. Some people never have Bell’s palsy again. For others, it comes back.

I returned to work on KSAT 4 1/2 weeks after being diagnosed. I’m not 100 percent yet. But for me, believing I’ll get there has helped me on my way.

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