bell's palsy

Understanding Bell’s Palsy: A Comprehensive Guide

Bell’s palsy is a neurological condition that strikes facial muscles abruptly, causing temporary weakness or paralysis on one side of the face. It occurs when the facial nerves are damaged or traumatized and can manifest suddenly, mostly by waking up in the morning or when trying to eat or drink. Bell’s palsy can happen to anyone regardless of age or sex; however, it mainly affects people between 15 and 60 years old. Bell’s palsy is more than just changing one’s appearance; it also disturbs one’s emotional well-being and self-esteem.

The real cause of Bell’s palsy remains largely unknown, although it is often associated with viral infections that cause inflammation and compression of the nerve that controls facial muscles. The start of Bell’s palsy has been associated with such conditions as herpes simplex, responsible for cold sores, as well as other viruses like influenza, mumps, and respiratory tract infections (Holland et al., 2017). Most patients with Bell’s palsy improve significantly within weeks to months, even without medical treatment.

Diagnosis of Bell’s palsy usually entails ruling out other conditions that can lead to paralysis of the face, like Lyme disease or a stroke. Such treatments may vary from corticosteroids aimed at alleviating inflammation, physical therapy used for stimulating facial muscles, and alternative methods such as acupuncture in some cases (Mohan & Rangarajan, 2013).

Awareness and understanding are important factors for individuals affected by this condition so they can seek prompt care and support. This all-inclusive blog post demystifies Bell’s palsy by providing an insight into symptoms experienced, the causes behind its occurrence, and various types of treatments administered for recovery, among others.

Demystifying Bell’s Palsy: Symptoms, Causes & Treatment Options

Bell’s Palsy is a neurological condition that leads to temporary weakness or paralysis of the facial muscles. Here we explore the symptoms, causes, and various treatment options for managing this condition.

What is Bell’s Palsy?

Bell’s Palsey refers to sudden weakness on one side of the face. When your eye cannot close properly, or you cannot smile well on one side of your face, it can be a sign of this disease. While the cause is not yet fully clear, there are often viral infections involved (Mayo Clinic, 2021). The good news is that many people with Bell’s Palsy see significant improvements within weeks, and a complete recovery is possible within six months, especially with early treatment (NHS, 2020). It can affect anyone, but it occurs more frequently in people between the ages of 15 and 60. However, Bell’s Palsy is generally self-limiting in nature despite its sudden onset, and understanding this would help individuals manage the condition better.

What Does Bell’s Palsy Look Like?

To identify this illness early enough for timely treatment, it is important to have a mental image of what Bell’s palsy entails. When half of your face seems to sag or stiffen, that could be an indication that you are having Bell’s palsy. On one side of their face, they may note that they seem to droop, making it difficult for them to close their eyes on that side, smile, or make other facial expressions as they usually do. Asymmetry not only affects facial expression but also renders everyday tasks like eating, drinking, or talking cumbersome for victims, making it awkward for those living with them.

Demystifying Bell's Palsy

These pictures usually demonstrate one side of the face looking relaxed or normal, while on the other hand there are noticeable changes such as a fallen eyebrow, the mouth corner not lifting and eye that does not completely shut. This makes it easier to identify symptoms through real – life examples for those affected, caregivers and family members thus creating a healing environment.

How do you know if you are getting Bell’s palsy?

Early recognition of Bell’s palsy onset enhances its recovery process. Key early signs include sudden weakness/ paralysis on one side of your face, making it hard to smile or close your eye on that side, according to John Hopkins Medicine.

One may also experience dribbling saliva from the mouth, increased sensitivity to sound in one ear, and mild pain or discomfort around the jaw or behind the ear before weakness appears. Such symptoms develop rapidly and might prompt patients with these conditions to consult medical advice instantly.

It is important for individuals to take heed of these early warning signs and seek an accurate diagnosis from health care providers as well as discuss possible treatment options that could alter their prognosis. 

What are the Symptoms of Bell’s Palsy?

Bell’s palsy symptoms can vary significantly among individuals but typically involve sudden facial muscle weakness or paralysis affecting only one side, hence making control difficult. Typical symptoms include:

  • The sudden weakness/ paralysis on one side of the face makes it difficult to smile or close an eye on that side.
  • Drooping of mouth corner or eyelid on one side
  • Increased sound sensitivity in one ear
  • Decreased ability to taste
  • Slight pain behind ear/ jaw area near upper teeth
  • Dry eye/mouth
  • Numbness feeling in affected half-face  

These symptoms peak within 48 hours and can make basic activities like eating, drinking, or speaking extremely difficult (Mayo Clinic, 2021). Individuals who experience these should promptly seek medical attention as early intervention has great effect towards recovery process. Moreover, knowing these symptoms helps to differentiate Bell’s Palsy from other severe conditions like strokes, thus prompting medical attention in good time.

What are the Causes of Bell’s Palsy?

The exact cause of Bell’s Palsy is still unknown, but many believe it is caused by viral infections that cause inflammation and damage to the facial nerve. Some of the viruses suspected to play a role include herpes simplex virus, which causes cold sores and genital herpes, and the varicella-zoster virus, responsible for chicken pox and shingles (American Academy of Otolaryngology–Head and Neck Surgery, 2022).

Other possible triggers are Epstein-Barr virus, known for causing mononucleosis, as well as brain infection-causing cytomegalovirus. In addition, diabetes mellitus, pregnancy, or having a respiratory tract infection has been associated with an increased risk of getting Bell’s palsy (Cleveland Clinic, 2021). Although these associations do not establish a direct cause-and-effect relationship, they highlight the importance of understanding the underlying health conditions that may predispose individuals to Bell’s Palsy.

What is the treatment for Bell’s palsy?

The primary remedy for Bell’s Palsy is focused on the relief of symptoms, inflammation reduction, and speeding up nerve growth. According to the latest research and recommendations by reputable health organizations, here are some common treatments:

Corticosteroids: Prednisone is the most commonly prescribed corticosteroid to decrease irritation/swelling of the facial nerve. Its effectiveness significantly increases when treatment begins within 72 hours of onset. A systematic review by the Cochrane Library underscores the role of prednisone in enhancing recovery rates among patients suffering from Bell’s palsy (Cochrane Database of Systematic Reviews, 2020).

Antiviral Medications: In case viral infection is considered as an etiological factor for Bell’s Palsy, antiviral agents such as acyclovir may be combined with corticosteroids. However, this strategy remains somewhat controversial, with mixed findings from previous studies. Annals of Internal Medicine published a study indicating that adding antivirals to corticosteroids did not make any significant difference in outcomes compared to corticosteroids alone; hence, individual case reviews recommend considering the use of antiviral drugs (Annals of Internal Medicine, 2021).

Physical Therapy: Physical therapy involving facial exercises can be used as a non-medication adjunctive therapy to prevent muscle contractures. Evidence about how well it works varies, but some people have said they are better off after trying it out. As per American Physical Therapy Association guidelines, it can assist patients in muscle reeducation and hasten healing through personalized exercises (APTA, 2022).

Eye Care: For those who find it difficult to close their eye(s), lubricating eye drops and ointments should be suggested to avoid dryness and damage to the cornea. The American Academy of Ophthalmology has published guidance outlining principles behind effective eye care, highlighting prevention against corneal damage via eye protective measures (AAO, 2022).

The choice of medication or combination of treatments is individual to specific symptoms and health conditions.

Medications for Bell’s Palsy

However, the appropriate dosage must be carefully prescribed by doctors depending on the severity of the patient’s condition as well as age of a victim. The primary course of treatment for Bell’s palsy includes corticosteroids and, in some cases, antiviral medications with specific dosages that should be calculated accordingly. Below is a summary of commonly used drugs and their indications in therapy.


Prednisone: For adults, they usually take 60mg per day for five days, followed by a tapering off over the ensuing five days. In children, dosing is typically calculated based on weight, approximately 1-2 mg/kg/day, not to exceed 60 mg per day, with a similar duration and tapering to that done in adults. Prednisone helps in reducing inflammation around the facial nerve relieving symptoms therefore promoting faster healing (Mayo Clinic, 2021).

Antiviral Medications (in conjunction with corticosteroids)

Acyclovir: Antivirals are still considered controversial nevertheless acyclovir can be added to corticosteroid if it is suspected that there is viral infection. Adults normally take 400mg five times a day for seven to ten days. However, children’s dosage needs adjustment according to body weight or at doctor’s discretion (Cochrane Database of Systematic Reviews, 2020).

It is important to note that these drugs must only be taken under medical supervision, which can give the most reliable advice based on the patient’s exact health profile and the latest research in medicine. Further, treatments are more effective if started as early as possible after symptom onset. For Bell’s Palsy, consult a healthcare provider always to obtain diagnostics for the best care plan and suitable doses for adults or children.

Bell’s Palsy Physical Therapy

Physical therapy has become an essential adjunct treatment of Bell’s palsy aimed at improving the function of facial muscles and preventing complications that may occur in the long term. A recommended program of facial exercises assists patients in regaining muscle control and reducing synkinesis incidence, which means situations when voluntary actions performed by the face lead to involuntary movements by other face muscles (Journal of Physical Therapy Science, 2019). 

Such exercises involve gentle stretches and movements targeting specific facial muscles encouraging nerve regeneration and reeducation of muscles. In addition, American Physical Therapy Association insists on starting physical therapy at the point where acute stage of the disease has stabilized so that patients could get the greatest advantage from such noninvasive method (APTA, 2022). You can find this page useful if you are looking for a PDF of physiotherapy for Bell’s palsy.

Final Words

In summary, treatment for Bell’s Palsy requires a comprehensive approach, given its unique presentation among physicians and sufferers alike. From the use of corticosteroids to reduce inflammation to whether antiviral medications should be used or not on top of using physical therapy during the treatment process (Athaide et al., 2013). It is vital for intervention timeliness as well as focused therapy principles, as described earlier, with adequate coaching services intended for patients. This will help improve recovery outcomes by adhering to guidelines provided by health organizations and seeking consultations from medics. Keep in mind each case of BP is different; hence, individualizing care plans must take into account the different needs and circumstances of the patient. By being aware as well as proactive, individuals affected by this condition, along with those caring for them, will be able to confidently walk the journey of recovery.


"Hasan", I am a physiotherapy Doctor. I have completed my B.S.c course (4 years) under Rajshahi University, Faculty of Medicine, Rajshahi. Currently I am working as a clinical physiotherapist at a renowned physiotherapy center and I am continuing my MPT (Master's of physiotherapy) degree at CRP, Savar.

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