What is Bells’ Palsy?
Some of my patients had complained of ear pain, jaw pain or tearing associated with the facial palsy.
Quickcare or ER?
The Red Flags that will send you to the ER are those things that point to a stroke or a tumor:
- Loss of consciousness
- Severe headache
- Weakness in other body parts
If none of those exist, then it is safe to be seen in the clinic.
Did you get Bells Palsy? Did you have a full recovery?
What will your doctor ask?
Your doctor will want to know your symptoms. A symptom is your description of your condition to your doctor. It is YOUR story.
Answers to the following questions will help
What were you doing when it started?
Are the symptoms coming and going?
Are they getting worse?
Do you have a headache?
Did you have any each discomfort prior to the palsy?
Was there any trauma or fighting prior to the paralysis?
What will you doctor look for?
Your doctor will look for SIGNS. A sign is an objective finding that your doctor will see during the examination.
A good neurological exam is warranted.
This exam starts with simply the doctor asking questions?
- What is your name?
- What day is it
- Where are you?
The neurologic exam will include checking for weakness in the arms and legs
The reflex hammer will check for reflexes.
Real quickly, the nerve in question in the seventh cranial nerve (CN VII). It passes from the base of the brain (see picture) to over the ear and then innervates the face.
A good head and neck exam are warranted.
Notice the following with Bells Palsy….
- The eye lid cannot close but the eye ball moves without difficulty.
- The mouth cannot make a smile but the tongue moves without difficulty.
- The upper face (forehead) is affected as is lower face around the mouth
What is the doctor thinking?
Your doctor will attempt to find other reasons for your facial weakness. The list of the other causes is called a differential diagnosis.
Key is to make sure there is nothing worrisome. That is, nothing that looks like a stroke. No loss of consciousness. No severe headache. No neck stiffness. No fever. No seizure. No mental status changes.
One diagnosis to consider is a benign mass called an acoustic neuroma. Associated symptoms may include hearing loss, ringing in the ears and/or and unsteady gait.
One unique condition..
What if Bells Palsy was on both sides of the face? I have only seen it once. My patient was a young man who I had seen twice in two weeks. First the left side was affected then the right side. He could not move any facial muscles. No smiling. No grimacing. No blinking.
If facial paralysis is on both sides of the face, consider Lyme Disease.
What is the treatment of Bells Palsy?
Before talking of treatment, you have to ask, “What caused it…Why me?”
There is no clear answer. Some say it is a virus. Others a simple swelling of a nerve (Cranial Nerve VII to be exact.)
Most times it will resolve.
I add a steroid Prednisone for a few days to calm the nerve down. Other may prescribe a anti-viral medication such as Acyclovir.
Some patients massage the back of the head behind the ear to relieve the inflammation of the nerve.
How long will you have Bells Palsy?
Bells Palsy may last for a few weeks, even with the steroid regimen.
There is a good chance that some (not all) of the paralysis will come back
Let me tell you a story….
“Dr Reyes. DR REYES!! I think I’m having a stroke,” said Marge. Hmm You are having a stroke but you are able to yell at me? That doesn’t make sense.
“What happened? What is going on?”- I ask
“Well, I was drinking my morning coffee and I kept spilling it from my mouth….like I was drooling. Then I noticed that I am numb on my face. I looked in the mirror and noticed that my face was drooping”.
She never passed out. She was always able to speak well. No confusion. No complaints of other parts of the body. Only the face.
In Marge’s case there were no severe headaches, passing out spells, seizures or paralysis on other parts of the body.
“Hmm. Let’s see. She is sitting up, talking, answering questions appropriately….Couldn’t be that bad.”
She had an isolated left facial droop that was constant. Nothing made it better or worse. No associated loss of consciousness was associated.
After one week of Acyclovir and Prednisone, she was much better. But, over the years, there still remained a slight facial droop.
I hope this helps
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