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Bell’s Palsy
Synonyms of Bell’s Palsy
Antoni's Palsy
Facial Nerve Palsy
Facial Paralysis
Idiopathic Facial Palsy
Refrigeration Palsy

General Discussion
Bell’s palsy is a non-progressive neurological disorder of one of the facial nerves (7th
cranial nerve). This disorder is characterized by the sudden onset of facial paralysis that
may be preceded by a slight fever, pain behind the ear on the affected side, a stiff neck, and
weakness and/or stiffness on one side of the face. Paralysis results from decreased blood
supply (ischemia) and/or compression of the 7th cranial nerve. The exact cause of Bell’s
palsy is not known. Viral (e.g., herpes zoster virus) and immune disorders are frequently
implicated as a cause for this disorder. There may also be an inherited tendency toward
developing Bell’s palsy.

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Signs & Symptoms

The early symptoms of Bell’s palsy may include a slight fever, pain behind the ear, a stiff
neck, and weakness and/or stiffness on one side of the face. The symptoms may begin
suddenly and progress rapidly over several hours, and sometimes follow exposure to cold
or a draft. Part or all of the face may be affected.
In most cases of Bell’s palsy, only facial muscle weakness occurs and the facial paralysis is
temporary. Most cases resolve with two to three weeks. Approximately 80 percent of
cases are resolved within three months. However, some cases persist. Occasionally, only
the upper or lower half the face is affected.
In severe cases of Bell’s palsy, the facial muscles on the affected side are completely
paralyzed, causing that side of the face to become smooth, expressionless, and immobile.
Often the opening between the upper and lower eyelids (palpebral fissure) is enlarged and
remains open during sleep. This may result in the inability to close the eye on the affected
side. People with Bell’s palsy may not have a corneal reflex; the eye on the affected side
does not close when the cornea is touched.

If the compressed region of the facial nerve is next to the branching of other nerves, there
may be a decrease in saliva and/or tear production. Some people with Bell’s palsy
experience a loss of the sense of taste on one side of the mouth, drooling, and an increased
sensitivity to sound (hyperacusis) on the affected side of the head. In some cases, an
affected individual’s response to a pinprick behind the ear also is decreased.
Recovery from Bell’s palsy depends on the extent and severity of damage to the seventh
cranial nerve. If facial paralysis is only partial, complete recovery can be expected. The
affected muscles usually regain their original function within one to two months. If, as
recovery proceeds, the nerve fibers regrow to muscles other than the ones they originally
innervated, there may be voluntary muscle movements of the face accompanied by
involuntary contractions of other facial muscles (synkinesia). Crocodile tears (tears not
brought on by emotion) associated with facial muscular contractions occasionally develop
in the aftermath of Bell’s palsy.

Causes
The exact cause of Bell’s palsy is not known. Viral and immune disorders are often
implicated as a cause for this disorder. There may also be an inherited tendency toward
developing Bell’s palsy. Symptoms develop due to deficiency of blood supply and pressure
on the 7th cranial nerve as a result of nerve swelling.

Affected Populations
Bell’s palsy is a fairly prevalent disorder that affects males and females in equal numbers. It
is estimated that between 25 and 35 in 100,000 people in the United States are affected
with Bell’s palsy. Approximately 40,000 individuals are diagnosed with Bell’s palsy in the
United States each year.

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Elderly individuals are more likely to develop Bell’s palsy than children, but the disorder
may affect individuals of any age. However, pregnant women or individuals with diabetes
or upper respiratory ailments are affected more often than the general population.

Related Disorders
Symptoms of the following disorders can be similar to those of Bell’s palsy. Comparisons
may be useful for a differential diagnosis:
Acoustic neuroma is a benign tumor of the 8th cranial nerve. This nerve lies within the
internal ear canal. Pressure on this nerve results in the early symptoms of acoustic
neuroma, a ringing sound in the ear (tinnitus), and/or hearing loss may occur. An associated
compression of the facial nerve (7th cranial nerve) may produce muscle weakness,
pressure on the trigeminal nerve (5th cranial nerve) may lead to facial numbness. The
expansion of the tumor into different areas may result in impaired ability to coordinate
movement of the legs and arms (ataxia), numbness in the mouth, slurred speech
(dysarthria), and/or hoarseness. (For more information in this disorder, choose “Acoustic
Neuroma” as your search term on the Rare Disease Database.)
Myasthenia gravis is a chronic neuromuscular disease characterized by muscle weakness.
Initially the muscles of the mouth, lips, tongue, and voice box are the most affected. The
early symptoms of this disorder may include difficulties in speaking, chewing, and/or
swallowing; the eyelids may droop and double vision may occur. When these symptoms
occur on one side (unilateral), the disorder may resemble Bell’s Palsy. Eventually muscle
weakness extends into the arms and legs resulting in generalized physical weakness. (For
more information on this disorder, choose “Myasthenia Gravis” as your search term in the
Rare Disease Database.)

Ramsay-Hunt syndrome (RHS), also known as herpes zoster oticus, is a rare neurological
disorder characterized by paralysis of certain facial nerves (facial palsy), a rash affecting
the ear or mouth, and ear abnormalities such as ringing in the ears (tinnitus). Ramsay-Hunt
syndrome is caused by the varicella zoster virus, the same virus that causes chickenpox in
children and shingles (herpes zoster) in adults. In cases of Ramsay-Hunt syndrome,
previously dormant varicella-zoster virus is reactivated and spreads to affect the facial
nerves. Affected individuals may experience hearing loss or intense pain by the ear. (For
more information in this disorder, choose “Ramsay-Hunt syndrome” as your search term
on the Rare Disease Database.)

Diagnosis
A preliminary diagnosis may be made by the physician upon looking at the patient's face
and noticing the difficulty the patient has in moving the facial muscles. Electromyography,
a test that measure the electrical conductivity of the nerve, may be administered to
confirm the diagnosis and to measure the extent of the nerve damage.

Standard Therapies
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Treatment
Most people with Bell's palsy recover fully without treatment. Massage and mild electrical
stimulation of the paralyzed muscles can help maintain facial muscle tone and prevent the
loss of muscle function. Treatment with oral corticosteroid drugs, such as prednisone, has
been more successful than surgical attempts to widen the facial canal.

Methylcellulose eye drops, eyeglasses or goggles, and/or temporary patching may help to
protect the exposed eye of people with Bell's palsy if they cannot close the eye. In
extremely severe cases, partial or total surgical closure of the eyelid on the affected side
(tarsorrhaphy) may protect the eye from permanent damage. In those rare cases when
Bell's palsy has caused permanent paralysis of one side of the face, the peripheral facial
nerve can be surgically connected with the spinal accessory or hypoglossal nerves to allow
some eventual return of muscle function.

Investigational Therapies
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All
studies receiving U.S. government funding, and some supported by private industry, are
posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in
Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

Supporting Organizations
Center for Peripheral Neuropathy
University of Chicago
5841 South Maryland Ave, MC 2030
Chicago, IL 60637
Phone: (773) 702-5659
Website: http://peripheralneuropathycenter.uchicago.edu/

Genetic and Rare Diseases (GARD) Information Center

PO Box 8126
Gaithersburg, MD 20898-8126
Phone: (301) 251-4925
Toll-free: (888) 205-2311
Website: http://rarediseases.info.nih.gov/GARD/

NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

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Bethesda, MD 20824
Phone: (301) 496-5751
Toll-free: (800) 352-9424
Website: http://www.ninds.nih.gov/

References
TEXTBOOKS
Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B.
Saunders Co; 1996:2157

Adams, RD, et al., eds. Principles of Neurology. 6th ed. New York, NY: McGraw-Hill,
Companies; 1997:1376

REVIEW ARTICLES

Siwula JM, Mathieu G. Acute onset of facial nerve palsy associated with Lyme disease in a 6
year-old child. Pediatr Dent. 2002;24:572-74.

Peiterson E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of
different etiologies. Acta Otolaryngol Suppl. 2002:4-30.

Gilbert SC. Bell’s palsy and herpesviruses. 2002;9:70-73.

Grose C, Bonthius D, Afifi AK. Chickenpox and the geniculate ganglion: facial nerve palsy,
Ramsay Hunt syndrome and acyclovir treatment. Pediatr Infect Dis J. 2002;186 Suppl
1:S71-77.

Salinas RA, Alvarez G, Alvarez MI, et al. Corticosteroids for Bell’s palsy (idiopathic facial
paralysis). Cochrane Database Syst Rev. 2002;(1):CD001942.

Sipe J, Dunn L. Aciclovir for Bell’s palsy (idiopathic facial paralysis). Cochrane Database
Syst Rev. 2001;(4):CD001869.
JOURNAL ARTICLES

Mutsch M, Zhou W, Rhodes P, et al. Use of the inactivated intranasal influenza vaccine and
the risk of Bell’s palsy in Switzerland. N Engl J Med. 2004;350:896-903.
Hato N, Matsumoto S, Kisaki H, et al. Efficacy of early treatment of Bell’s palsy with oral
acyclovir and prednisolone. Otol Neurotol. 2003;24:948-51.

Kilie R, Ozdek A, Felek S. et al. A case presentation of bilateral simultaneous Bell’s palsy.
Am J Otolaryngol. 2003;24:271-73.

Cronin GW, Steenerson RL. The effectiveness of neuromuscular facial retraining combined
with electromyography in facial paralysis rehabilitation. Otolaryngol Head Neck Surg.
2003;128:534-38.

Price T, Fife DG. Bilateral simultaneous facial nerve palsy. J Laryngol Otol. 2002;116:46-
48.

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Keegan DJ, Geerling G, Lee JP, et al. Botulinum toxin treatment for hyperlacrimation
secondary to aberrant regenerated seventh nerve palsy or salivary gland transplantation.
Br. J Ophthalmol. 2002;86:43-46.

ARTICLES REPORTING THE RESULTS OF CLINICAL TRIALS

Lagalla G, Logullo F, Di Bella P, et al. Influence of early high-dose steroid treatment on Bell’s
palsy evolution. Neurol Sci. 2002;23:107-12.

Koriyama T, Inafuku S, Kimata K, et al. Recent-onset Bell’s palsy complicated by diabetes:

comparison of steroid and lipoprostaglandin E(1) therapy. Arch Otolaryngol Head Neck
Surg. 2001;127:1338-40.

Salman MS, MacGregor DL. Should children with Bell’s palsy be treated with
corticosteroids? A systematic review. J Child Neurol. 2001;16:565-68.

FROM THE INTERNET

NINDS Bell’s Palsy Information Page. Reviewed 04-02-2003. 2pp.

www.ninds.nih.gov/health_and_medical/disorders/bells_doc.htm

Doctor, What Is Bell’s Palsy? AAO-HNS (American Academy of Otolaryngology-Head and

Neck Surgery). 2002. 4pp.
www.entnet.org/healthinfo/topics/bells.cfm

Bell’s palsy. Mayo Clinic Staff. Mayo ClinicApril 02, 2002. 3pp.

www.mayoclinic.com/invoke.cfm?id=DS00168

Bell’s Palsy. Department of Otolaryngology / Head and Neck Surgery. nd. 3pp.

www.entcolumbia.org/bells/htm
Hain TC. Bell’s Palsy. Neurology. Northwestern University Medical School. 2001. 3pp.
www.neuro.nwu.edu/meded/CRANIAL/bells.html

Years Published
1985, 1990, 1993, 1997, 2001, 2005

The information in NORD’s Rare Disease Database is for educational purposes only and is not intended to replace the
advice of a physician or other qualified medical professional.

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Report Index
Synonyms
General Discussion
Signs & Symptoms
Causes
Affected Populations
Related Disorders
Standard Therapies
Investigational Therapies
Supporting Organizations
References

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