Bell’s Palsy is an acquired condition that results in temporary, non-progressive paralysis or weakness of the face, generally on one side. Bell’s Palsy is named after Sir Charles Bell, a 19th-century Scottish surgeon who was the first to describe the condition. This condition presents with a sudden onset of facial paralysis or weakness, developing within 48 hours, along with a mild fever, pain behind the ear or of the face on the affected side, and a stiff neck. The condition is also known as Antoni’s Palsy, Facial Nerve Palsy, Facial Paralysis, Idiopathic Facial Palsy, or Refrigeration Palsy. Bell’s Palsy is often caused by viral infections, however immune disorders and inherence are also implicated in acquiring Bell’s Palsy.

How common is Bell’s Palsy?

According to statistics from the National Organization for Rare Disorders (NORD), Bell’s Palsy is common amongst the American population, affecting males and females in equal numbers. It is estimated that between 25 to 35 in every 100,000 people in the United States are affected with Bell’s Palsy, with approximately 40,000 individuals being diagnosed with Bell’s Palsy in the United States every year. Pregnant women and individuals with diabetes are also susceptible to developing Bell’s Palsy. Children have the lowest chance of acquiring the condition, but also have the best prognosis is in children. 

What is the cause of Bell’s Palsy?

The precise cause of Bell’s Palsy is still under investigation, but research from the National Institute for Health (NIH) suggests it may be caused by inflammation of the facial nerve due to a viral infection. A weakened immune system caused by stress, sleep deprivation, trauma, illness, or autoimmune diseases may trigger or worsen the effects of Bell’s Palsy. Inflammation is caused by “nerve-loving” organisms that invade the nerves when one is infected with a virus. The inflammation of the nerve results in decreased blood supply or compression of the nerve. The decreased blood supply results in nutrient-rich blood not reaching the muscles or feeding the nerve. Whilst compression of the nerves results in inhibition of signals sent from the central nervous system to the facial muscles. 

What are the symptoms and effects of Bell’s Palsy?

The presentation of Bell’s Palsy can be understood by considering the function that the facial nerve plays in motor control of the muscles of our face. The facial nerve is the 7th cranial nerve that originates from the brainstem, runs along the base of our skull, and exits near the jaw to branch out to supply the muscles of the face. The facial nerve provides us with the ability to wink, close our eyes, chew, taste, whistle, and smile. It is also responsible for tear and salivary gland production and carries signals to the stapedial muscles of the stapes bone in the middle ear. 

The symptoms and effects of Bell’s Palsy are diverse and widespread due to the complexity of the facial nerve. Symptoms vary between individuals ranging from mild weakness to complete paralysis. The most common symptom is sudden weakness of one side of the face. Almost 70% of individuals who get Bell’s Palsy develop a rapid onset, single-sided facial paralysis, whilst the remaining individuals develop facial weakness that is not localized and may be felt in different areas of the face. Other symptoms may include drooping of the mouth, inability to control saliva production resulting in drooling, inability to close eye causing dryness of the eye, and excessive tearing in one eye. Individuals may also have facial pain or abnormal sensation, altered taste, and auditory difficulties such as an intolerance to loud noise, dizziness, ringing in the ear, and hearing loss. 

The association between Bell’s Palsy and communicative difficulties

Due to the proximity of the facial nerve to other nerves, inflammation of the facial nerve may impact the nerve responsible for hearing and balance information. This may result in hearing loss and difficulties with balance. Individuals may also experience dizziness, and ringing in the ear. This occurs rarely and is experienced in severe cases in which extensive inflammation is present. More frequently, a sensitivity to loud noises referred to as hyperacusis is experienced as the facial nerve carries signals to the muscles in the middle ear system that is responsible for translating vibrations from the eardrum to the inner ear where it is understood. The sensitivity to loud noises is pervasive and may infringe on your ability to complete daily tasks as sharp sounds become painful to manage. 

Dysfunction of the facial nerve results in poor communicative ability due to reduced control of the facial muscles, lips, and salivary gland production. This may prove difficult when attempting to produce words and partake in communicative interactions. Utterances may become slurred and poorly enunciated due to diminished control. These factors coupled with poor salivary gland control may reduce one’s likelihood to participate socially due to fear of being embarrassed.

Managing Bell’s Palsy communicative difficulties

Managing sensitivity to loud sounds involves gradual acclimatisation to the sounds or the fitment of a device that allows for the uncomfortable sounds to be masked. Acclimatisation of sounds can be achieved by identifying the sounds that cause discomfort and limiting your exposure to them as far as possible. If you are unable to limit exposure, use hearing protective devices such as earplugs or earmuffs. Additionally, one can train the mind to focus on other sounds in the environment. Often the effects of an uncomfortable sound can be enhanced if it is focussed on. 

A visit to a hearing health professional is important to determine the extent of your sensitivity, and whether it is caused by the paralysis. The hearing health professional will then recommend devices that may be used to mask the sound or provide exercises in which sounds from your environment or home may be used as natural maskers. 

Communicative difficulties can be managed by conducting facial exercises in your home or with the help of a physical therapist and completing pronunciation tasks. Exercises include massaging the face in circular motions on the affected. Massaging the face provides stimulation to the affected muscles, and its effects may be experienced more intensely as the condition improves.

Pronunciation tasks can be completed in front of a mirror. One can begin by saying each of the vowels in a dramatized fashion so that the facial muscles is utilized effectively. Video recording oneself daily can be used to document progress and be a motivating factor in continuing with the exercises. 

What is the treatment and prognosis for Bell’s Palsy?

The treatment of Bell’s Palsy is varied and is dependent on the extent of the condition. Some cases are mild and may not require treatment, as the symptoms diminish within 2 weeks. Treatment may also include medications such as steroids and antiviral drugs and therapeutic options such as physical therapy.

The prognosis for individuals with Bell’s Palsy is generally positive, with recovery being dependant on the extent of the nerve damage. Over 70% of individuals return to normal within a month. Prognosis is poorest amongst the elderly and long-term diabetics, but the most experience at least some recovery of function.

Bell’s Palsy is a multi-faceted condition that is varied in symptom presentation and recovery. Early diagnosis is important for optimal recovery and one should seek medical assistance if symptoms are experienced. 

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