Bell’s Palsy: The Best Path to Recovery

Bell’s palsy is perhaps best known for its hallmark symptom—the drooping of one side of the face. But by seeking steroid treatment at the first sign of symptoms, you stand a better chance of a full recovery. Here's what you need to know.

The disorder, which weakens or paralyzes facial muscles, is temporary for most people, even without treatment, although up to 30 percent of patients with Bell’s palsy fail to recover full strength in their facial muscles.

The American Academy of Neurology updated its treatment guidelines for Bell’s palsy in 2012 after reviewing data from nine past studies that involved treating patients with steroids and/or antiviral drugs.

The AAN found that most people who took oral steroids (already a mainstay of Bell’s palsy treatment) during the first three days of symptoms improved and regained their full facial function. Those taking antiviral medications alone didn't get better.

The updated guidelines state that it’s “highly likely steroids are effective in increasing the probability” of regaining full facial function.

What causes Bell’s palsy?

Bell’s palsy occurs as a result of damage to a facial nerve that controls muscle movement in the face. The nerve can become inflamed, swollen, or compressed. But it’s not known what exactly causes the damage.

Most scientists believe the herpes simplex virus—the same virus that leads to cold sores and genital herpes—is the most common cause of the nerve damage, but this remains controversial.

Other viral infections, such as herpes zoster (shingles), cytomegalovirus (similar to the viruses associated with chicken pox and herpes), and Epstein-Barr virus, are also suspect, as is Lyme disease.

These infections may cause the facial nerve to swell and become inflamed. The swelling can compress or “pinch” the nerve, impairing signals from the brain and resulting in temporary weakness or paralysis.

Bell’s palsy onset can be sudden, and symptoms typically worsen over 48 hours. Symptoms range from mild to severe and can vary from person to person. (In rare cases, symptoms can affect both sides of the face.) In addition to facial weakness or paralysis, symptoms may include:

- A drooping eyebrow, eyelid, and/or corner of the mouth on one side of the face
- No feeling on one side of the face
- Drooling
- Facial twitching
- Headache
- Excessive tearing
- Inability to close one eye, squint or blink, leading to dry eye
- Dry mouth
- Loss of sense of taste
- Sensitivity to loud noises

Symptoms may begin to subside after two weeks, especially if they’re mild. The more nerve damage you have, the longer it takes to recover. If your symptoms improve after 21 days, it’s a good indicator that you’ll fully recover. Most people regain full facial function within three to six months of symptom onset.

Bell’s palsy afflicts about 30,000 to 40,000 Americans each year, according to the AAN. It can appear at any age, but after age 60, your odds of being affected by the disorder begin to drop.

Steroids: A proven treatment

Undergoing early short-term steroid treatment of about five to 10 days increases your probability of a full recovery from Bell’s palsy.

The AAN advises that you take oral steroids, such as prednisone, preferably within three days of symptom onset. The steroids appear to reduce the inflammation in the face.

However, if you have poorly controlled diabetes, low bone density or an intolerance to steroids, or if you are morbidly obese, your doctor may advise against taking steroids because of potential complications.

In its analysis, the AAN found that antiviral drugs alone, such as acyclovir or valacyclovir, didn’t help improve recovery. It found only a slight benefit in combining an antiviral with a steroid.

Finally, if symptoms affect your ability to blink or fully close your eye(s), you need to take special precautions to prevent dry eye and possible damage to your cornea.

Administering hourly drops of artificial tears and applying a protective ointment nightly can help keep your eye lubricated. Your doctor may also suggest that you wear eyeglasses or goggles during the day, and an eye patch while you sleep.

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HealthAfter50 was published by the University of California, Berkeley, School of Public Health, providing up-to-date, evidence-based research and expert advice on the prevention, diagnosis, and treatment of a wide range of health conditions affecting adults in middle age and beyond. It was previously part of Remedy Health Media's network of digital and print publications, which also include HealthCentral; HIV/AIDS resources The Body and The Body Pro; the UC Berkeley Wellness Letter; and the Berkeley Wellness website. All content from HA50 merged into in 2018.