Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentA Word From Verywell
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
A Word From Verywell
Bell’s palsy is a condition that causes partial or complete weakness of one side of the face. The symptoms ofBell’s palsy, such as a sagging eyebrow or drooping mouth corner, develop pretty quickly and can dramatically change one’s appearance. Symptoms of Bell’s palsy usually improve on their own within a few months. Corticosteroids are typically prescribed to optimize a person’s chance for a full recovery.
Verywell / JR Bee
Bell’s Palsy Symptoms
The symptoms of Bell’s palsy usually come on suddenly (over a few hours) and typically worsen over the course of a few days before stabilizing.
Bell’s palsy affects one side of the face. It can cause partial or complete facial weakness, including in the forehead,eyelid, cheek, and mouth. Common findings on the affected side include:
In addition, Bell’s palsy can cause difficulties with eating and drinking, and patients may notice some drooling.Problems with theability to taste foodmay also occur.A person’s speech can also sound a bit slurred due to difficulty controlling the muscles of their mouth.
Bell’s palsy can also cause dryness and even redness of the eye due to decreased blinking, incomplete eyelid closing, and diminished facial tears.
Lastly, some people with Bell’s palsy experience ear discomfort with loud noises (i.e., hyperacusis).
For most people, symptoms of Bells palsy resolve within two weeks to a few months. Sometimes, after an episode of Bell’s palsy is largely resolved, a person may continue to have slight weakness of their face that can last for years.
Bell’s palsy is more common in adults than in children, and it is not a sign of any serious health problem. It is aperipheral neuropathy(nerve disease) of thefacial nerve, which is the seventh cranial nerve. This nerve comes off the brain stem and controls facial movement. When the facial nerve is inflamed and swollen (as in Bell’s palsy), it cannot properly communicate with the facial muscles, which leads to weakness.
Bell’s palsy is usually diagnosed based on a person’s symptoms and a physical exam. That said, Bell’s palsy is generally considered a diagnosis of exclusion, meaning additional diagnostic studies are often needed to rule out other mimicking conditions.
Some of these possibilities are very serious, so referral to aneurologistor otolaryngologist as soon as possible is warranted. The following are some tests that might be done.
Physical Exam
If one side of your face is weak, your healthcare provider will examine you to check for serious, brain-related causes of facial weakness, such as astroke.
Peripheral Nervous System Involvement (e.g., Bell’s Palsy)Weakness of the lower and upper parts of the faceLoss of forehead movementCentral Nervous System Involvement (e.g., Stroke)Weakness of the lower part of the facePreserved forehead movement
Peripheral Nervous System Involvement (e.g., Bell’s Palsy)Weakness of the lower and upper parts of the faceLoss of forehead movement
Weakness of the lower and upper parts of the face
Loss of forehead movement
Central Nervous System Involvement (e.g., Stroke)Weakness of the lower part of the facePreserved forehead movement
Weakness of the lower part of the face
Preserved forehead movement
This distinction is due to the way nerves run from the brain to the face. Basically, your forehead receives connections from both sides of the brain, whereas the lower part of the face receives connections from just one side of the brain.
This means that a person with a problem in the brain (stroke) would have preserved forehead movement while a person with a problem with the facial nerve (Bell’s palsy) would have a loss of forehead movement.
In the end, while Bell’s palsy is not as serious a condition as brain disorders that can cause similar symptoms, the facial weakness with Bell’s is usually more severe.
Bell’s Palsy vs. Stroke: What Are the Differences?
Ear Exam
Since one-sided facial weakness may result from abacterial infection of the middle ear, or as a complication of herpes zoster infection (shingles)—calledRamsay Hunt syndrome—your healthcare provider will also examine your ear.
Imaging Tests
Various imaging tests, such as brainmagnetic resonance imaging (MRI)andcomputed tomography (CT scan), can be helpful in teasing out alternative diagnoses like stroke, tumor,multiple sclerosis, and an uncommon inflammatory disease calledsarcoidosis.
Blood Tests
Sometimes blood tests are warranted to rule out other causes of facial paralysis, most commonlyLyme diseaseand less commonly,HIV infectionor an autoimmune disease likeSjögren’s disease.
Electromyography (EMG)
For people with more severe cases of Bell’s palsy, such as complete paralysis of the facial nerve, a healthcare provider may recommend anelectromyography (EMG)to help predict prognosis and/or provide guidance on a treatment plan.
Much of the time, weakness of one side the face turns out to be Bell’s palsy. But it is important for you to know that weakness of the face can be a stroke or another neurological condition, so seek medical attention without delay.
While there is no medication or therapy that can cure Bell’s palsy,corticosteroids(e.g., prednisone) have been found in various studies to improve both speed of recovery and chances for a full recovery.
Anantiviral medication, such as Valtrex (valacyclovir), is sometimes prescribed along with corticosteroids for the treatment of Bell’s palsy. However, the effectiveness of antiviral therapy for this purpose is highly debated, as most studies show no benefit compared with placebo.
Eye Care
One major concern associated with Bell’s palsy is the affected eye. Due to incomplete eyelid closure and impaired tear production in that eye, the eyeball can become dry, red, or itchy.
This is why those with Bell’s palsy should useartificial tears, which are available over the counter. Your healthcare provider may also recommend using an eye patch at night to prevent irritation.
Complementary Therapies
A few different complementary therapies, such as electrical nerve stimulation, acupuncture, and facial exercises, may also be useful in the management of Bell’s palsy, although research backing these therapies is scant.
What Does a Stroke Look Like?
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH National Institute of Neurological Disorders and Stroke.Bell’s palsy.MedlinePlus.Bell palsy.Pavlidis P, Cámara RJA, Kekes G, Gouveris H.Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.Ann Neurol. 2018 Apr;83(4):807-815. doi:10.1002/ana.25210De Seta D, Mancini P, Minni A, et al.Bell’s palsy: symptoms preceding and accompanying the facial paresis.Scientific World Journal. 2014;2014:801971. doi:10.1155/2014/801971Jeon Y, Lee H.Ramsay Hunt syndrome.J Dent Anesth Pain Med. 2018;18(6):333-337. doi:10.17245/jdapm.2018.18.6.333Yoo HW, Yoon L, Kim HY, et al.Comparison of conservative therapy and steroid therapy for Bell’s palsy in children.Korean J Pediatr. 2018;61(10):332-337. doi:10.3345/kjp.2018.06380Holland NJ, Bernstein JM.Bell’s palsy.BMJ Clin Evid. 2014;2014:1204.Additional ReadingAlbers JR, Tamang S.Common questions about Bell palsy.Am Fam Physician. 2014 Feb 1;89(3):209-12. https://www.aafp.org/afp/2014/0201/p209.htmlMaller T, Goldenstein S, Ronen O.Prevalence and characteristics of hearing loss in patients diagnosed with Bell’s palsy.Eur Arch Otorhinolaryngol. 2018 Jan;275(1):99-102. doi:10.1007/s00405-017-4816-0. Epub 2017 Nov 21.Salinas RA, Alvarez G, Daly F, Ferreira J.Corticosteroids for Bell’s palsy (idiopathic facial paralysis).Cochrane Database Syst Rev. 2010 Mar 17;(3):CD001942. doi:10.1002/14651858.CD001942.pub4Zandian A, Osiro S, Hudson R, et al.The neurologist’s dilemma: a comprehensive clinical review of Bell’s palsy, with emphasis on current management trends.Med Sci Monit. 2014;20:83-90. doi:10.12659/MSM.889876
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH National Institute of Neurological Disorders and Stroke.Bell’s palsy.MedlinePlus.Bell palsy.Pavlidis P, Cámara RJA, Kekes G, Gouveris H.Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.Ann Neurol. 2018 Apr;83(4):807-815. doi:10.1002/ana.25210De Seta D, Mancini P, Minni A, et al.Bell’s palsy: symptoms preceding and accompanying the facial paresis.Scientific World Journal. 2014;2014:801971. doi:10.1155/2014/801971Jeon Y, Lee H.Ramsay Hunt syndrome.J Dent Anesth Pain Med. 2018;18(6):333-337. doi:10.17245/jdapm.2018.18.6.333Yoo HW, Yoon L, Kim HY, et al.Comparison of conservative therapy and steroid therapy for Bell’s palsy in children.Korean J Pediatr. 2018;61(10):332-337. doi:10.3345/kjp.2018.06380Holland NJ, Bernstein JM.Bell’s palsy.BMJ Clin Evid. 2014;2014:1204.Additional ReadingAlbers JR, Tamang S.Common questions about Bell palsy.Am Fam Physician. 2014 Feb 1;89(3):209-12. https://www.aafp.org/afp/2014/0201/p209.htmlMaller T, Goldenstein S, Ronen O.Prevalence and characteristics of hearing loss in patients diagnosed with Bell’s palsy.Eur Arch Otorhinolaryngol. 2018 Jan;275(1):99-102. doi:10.1007/s00405-017-4816-0. Epub 2017 Nov 21.Salinas RA, Alvarez G, Daly F, Ferreira J.Corticosteroids for Bell’s palsy (idiopathic facial paralysis).Cochrane Database Syst Rev. 2010 Mar 17;(3):CD001942. doi:10.1002/14651858.CD001942.pub4Zandian A, Osiro S, Hudson R, et al.The neurologist’s dilemma: a comprehensive clinical review of Bell’s palsy, with emphasis on current management trends.Med Sci Monit. 2014;20:83-90. doi:10.12659/MSM.889876
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
NIH National Institute of Neurological Disorders and Stroke.Bell’s palsy.MedlinePlus.Bell palsy.Pavlidis P, Cámara RJA, Kekes G, Gouveris H.Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.Ann Neurol. 2018 Apr;83(4):807-815. doi:10.1002/ana.25210De Seta D, Mancini P, Minni A, et al.Bell’s palsy: symptoms preceding and accompanying the facial paresis.Scientific World Journal. 2014;2014:801971. doi:10.1155/2014/801971Jeon Y, Lee H.Ramsay Hunt syndrome.J Dent Anesth Pain Med. 2018;18(6):333-337. doi:10.17245/jdapm.2018.18.6.333Yoo HW, Yoon L, Kim HY, et al.Comparison of conservative therapy and steroid therapy for Bell’s palsy in children.Korean J Pediatr. 2018;61(10):332-337. doi:10.3345/kjp.2018.06380Holland NJ, Bernstein JM.Bell’s palsy.BMJ Clin Evid. 2014;2014:1204.
NIH National Institute of Neurological Disorders and Stroke.Bell’s palsy.
MedlinePlus.Bell palsy.
Pavlidis P, Cámara RJA, Kekes G, Gouveris H.Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.Ann Neurol. 2018 Apr;83(4):807-815. doi:10.1002/ana.25210
De Seta D, Mancini P, Minni A, et al.Bell’s palsy: symptoms preceding and accompanying the facial paresis.Scientific World Journal. 2014;2014:801971. doi:10.1155/2014/801971
Jeon Y, Lee H.Ramsay Hunt syndrome.J Dent Anesth Pain Med. 2018;18(6):333-337. doi:10.17245/jdapm.2018.18.6.333
Yoo HW, Yoon L, Kim HY, et al.Comparison of conservative therapy and steroid therapy for Bell’s palsy in children.Korean J Pediatr. 2018;61(10):332-337. doi:10.3345/kjp.2018.06380
Holland NJ, Bernstein JM.Bell’s palsy.BMJ Clin Evid. 2014;2014:1204.
Albers JR, Tamang S.Common questions about Bell palsy.Am Fam Physician. 2014 Feb 1;89(3):209-12. https://www.aafp.org/afp/2014/0201/p209.htmlMaller T, Goldenstein S, Ronen O.Prevalence and characteristics of hearing loss in patients diagnosed with Bell’s palsy.Eur Arch Otorhinolaryngol. 2018 Jan;275(1):99-102. doi:10.1007/s00405-017-4816-0. Epub 2017 Nov 21.Salinas RA, Alvarez G, Daly F, Ferreira J.Corticosteroids for Bell’s palsy (idiopathic facial paralysis).Cochrane Database Syst Rev. 2010 Mar 17;(3):CD001942. doi:10.1002/14651858.CD001942.pub4Zandian A, Osiro S, Hudson R, et al.The neurologist’s dilemma: a comprehensive clinical review of Bell’s palsy, with emphasis on current management trends.Med Sci Monit. 2014;20:83-90. doi:10.12659/MSM.889876
Albers JR, Tamang S.Common questions about Bell palsy.Am Fam Physician. 2014 Feb 1;89(3):209-12. https://www.aafp.org/afp/2014/0201/p209.html
Maller T, Goldenstein S, Ronen O.Prevalence and characteristics of hearing loss in patients diagnosed with Bell’s palsy.Eur Arch Otorhinolaryngol. 2018 Jan;275(1):99-102. doi:10.1007/s00405-017-4816-0. Epub 2017 Nov 21.
Salinas RA, Alvarez G, Daly F, Ferreira J.Corticosteroids for Bell’s palsy (idiopathic facial paralysis).Cochrane Database Syst Rev. 2010 Mar 17;(3):CD001942. doi:10.1002/14651858.CD001942.pub4
Zandian A, Osiro S, Hudson R, et al.The neurologist’s dilemma: a comprehensive clinical review of Bell’s palsy, with emphasis on current management trends.Med Sci Monit. 2014;20:83-90. doi:10.12659/MSM.889876
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