Bell's Palsy Treatments and Medications

Bell’s palsy is a mysterious condition. Symptoms can arise suddenly but spontaneously remit in a few weeks for most people. Some symptoms include the face going limp, not being able to open your eyes, or raising an eyebrow without great effort. When symptoms or complications persist, physical therapy and surgery might help.

What is Bell's palsy?

Bell’s palsy—also called acute peripheral facial palsy—is paralysis or weakness in one half of the face due to swelling and compression (squeezing) of the seventh cranial nerve. This nerve branches out to the nerves that control the facial muscles, saliva glands, tear glands, and the nerve that transmits taste sensations.

Bell’s palsy is an uncommon condition, but anyone can get it. About 30- to 40,000 people experience a bout with Bell’s palsy each year. Symptoms come on quickly—within hours or days—and peak in about three days. The vast majority of patients fully recover without treatment in less than three weeks.

Researchers are baffled about what causes Bell’s palsy, so they classify the condition as “idiopathic facial paralysis.” One theory holds that the condition is triggered by a viral infection. Culprits include the cold sore virus (herpes simplex virus), chickenpox, shingles (or herpes zoster) virus (varicella-zoster virus), the mononucleosis virus (Epstein-Barr), and a litany of other viral suspects. Most people who get Bell’s palsy, however, have no evidence of a viral infection, so some researchers believe it might be due to an immune response or autoimmune disorder.

No matter what the cause, swelling damages the cranial nerve. In most cases (70%), cranial nerve damage is superficial and limited to the protective sheath around the cranial nerve. The body repairs the damage quickly, and complete recovery is achieved within two to five weeks. If there is more extensive damage to the nerve—the “wires” themselves are cut—the body needs to repair the damage by regrowing new nerves to the facial muscles. Not only is recovery slow, but the process is imperfect and may result in long-term or permanent complications such as

• Permanent facial muscle weakness

• Shortening (contracture) of the facial muscles on the affected side

• Tightness or rigidity of the facial muscles on the affected side

• Pulling sensations in the face

• Synkinesis, that is, moving one part of the face provokes an involuntary movement in another part of the face. For instance, a person may try to smile, but the eyelid closes instead

How is Bell's palsy diagnosed?

Bell’s palsy is diagnosed primarily from the symptoms. Imaging and blood tests are unnecessary unless a healthcare provider suspects another condition might be responsible for the paralysis.

Some people are more at risk for Bell’s than others. Age (40-49), pregnancy, diabetes, preeclampsia, obesity, and high blood pressure are all risk factors.

In a physical examination, a healthcare provider will be looking for specific Bell’s palsy symptoms:

• Rapid onset of symptoms

• Weakness or paralysis of all the muscles on one side of the face

• Weakness or paralysis of the forehead on the affected side of the face

• Drooping eyebrow

• Inability to fully close the eyelid on the affected side

• Decreased tear or saliva production

• Drooling

• Loss of taste

• Pain behind the ear or around the jaw

Because one eyelid may not close, eye irritation and dry eye are also common symptoms of Bell’s palsy. Even though tear production goes down, the drooping of the lower eyelid may result in a steady flow of tears, called crocodile tears.

There is a high chance that adults and especially children with Bell’s palsy actually have another—often more serious— condition such as Lyme disease, ear infection (otitis media), Ramsay Hunt syndrome, sarcoidosis, Guillain-Barre syndrome, cancer, stroke, or multiple sclerosis. Both the physical and the medical history will help a physician determine if some other illness is at work.

If there are no signs of another possible condition, a physician can make a diagnosis based only on the history and symptoms.

If the paralysis is severe, the physician may order nerve conduction studies or an electromyography (EMG) to determine how well facial nerves are working. Magnetic resonance imaging (MRI) or a CT scan will be ordered if the physician suspects the symptoms are caused by another condition.

Bell's palsy treatment options

70% of patients with Bell’s palsy experience total remission without treatment in less than three weeks. Half of the remaining patients experience near-total remission by three months. Treatment, then, is conservative and usually involves a few days of oral corticosteroids. Persistent symptoms or complications can be managed with surgery or physical therapy.

Medications

Bell’s palsy is nearly always treated with oral corticosteroids alone or in combination with antiviral agents. Corticosteroids reduce swelling, alleviate symptoms, speed recovery, and reduce the risk of complications. It’s uncertain if adding antiviral treatment does any good, but it may slightly reduce the risk of complications.

Surgery

Occasionally, doctors perform surgical decompression, removing some of the swollen tissue around the irritated nerve, on patients with severe and persistent Bell’s palsy symptoms, but it is only employed in rare cases.

For patients with persistent symptoms, eyelid surgery may be required to prevent injury to the eye. If the eyelid doesn’t close, dry eye can then cause tears and ulcers. Surgery may involve implanting eyelid weights or sewing the corners of the eyelids together to narrow the opening (tarsorrhaphy).

Synkinesis or muscle tightness can be treated with botulinum toxin injections. Botulinum toxin temporarily paralyzes the nerves, causing involuntary facial movements and restoring normal facial function for a few months.

Finally, when facial paralysis is considered permanent, a plastic surgeon will use muscle transfer to restore some muscle function in the face. This involves cutting a part of a working muscle in the face and connecting that part to an area of the face that’s paralyzed.

Physical therapy

For patients with persistent complications due to Bell’s palsy—such as synkinesis—facial neuromuscular retraining uses a series of exercises to teach patients how to re-coordinate facial movements. Most of the exercises can be done at home.

Bell's palsy medications

Bell’s palsy has a high rate of spontaneous recovery, so healthcare providers use drugs conservatively. Nearly all patients will be given a few days of corticosteroids, but more severe cases will include antiviral agents. Pain and headache can be alleviated with over-the-counter pain relievers.

Corticosteroids

Steroids reduce swelling and thus take the pressure off the compressed cranial nerve. Research has shown that no matter how severe the paralysis, corticosteroids speed recovery, alleviate symptoms, and reduce other consequences such as synkinesis. Oral prednisone or prednisolone is given over ten days in a tapering dose.

Antivirals

Bell’s palsy may or may not be related to a viral infection, so severe cases will involve early treatment with antiviral medications and corticosteroids to reduce the risk of complications. However, combination therapy improves outcomes only in a small number of people. Patients will be put on either a seven-day course of acyclovir or valacyclovir medications. These drugs slow down the growth of herpes and varicella-zoster viruses.

Pain relievers

For patients experiencing pain or headache due to Bell’s palsy, over-the-counter pain relievers are enough to manage the pain. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen, naproxen, or aspirin, not only alleviate pain but help to reduce swelling. Acetaminophen, an over-the-counter pain reliever, can be used by people who are unable to tolerate NSAIDs.

What is the best medication for Bell's palsy?

Healthcare professionals use medications primarily to speed recovery and reduce the risk of nerve damage and long-term complications. Because each case is different, there is no “best” medication for Bell’s palsy.

Save big on your prescriptions

with the free SingleCare app.

4.8 average rating

Text a link to get the app

Send

Best medications for Bell’s palsy