ASK THE DOCTOR: Bell's Palsy
By DR. JIM MITTERANDO

Q I was recently diagnosed with Bell's palsy two weeks ago and I am very worried about my slow progress. I still have weakness of my left face and cannot close my eye. My doctor said most cases resolve but can take months. What can I do to get better faster?

A Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face. Affecting 1 percent of people, the disorder results from damage to a facial nerve that runs beneath each ear to the muscles of the face.

The condition may result in a droopy appearance to your face which can be quite distressing. Other associated symptoms may include a dry eye or frequent tears, pain in or behind the ear, numbness of the face, oversensitivity to sounds or decreased taste.

Most cases of Bell's palsy are believed to be due to a viral infection that causes the facial nerve to swell. Occasionally, Lyme disease can cause Bell's palsy. The nerve swelling may ‘‘pinch'' the nerve as it exits the skull underneath the ear causing nerve damage.

It is important that anyone with facial weakness contact their doctor to determine whether further evaluation or treatment is necessary.

Your doctor often can diagnose Bell's palsy simply by looking at your face and asking you to try to move your facial muscles. Most cases of Bell's palsy do not need any testing (i.e. blood test or CT scan or MRI). Other conditions, such as a stroke and tumors, also may cause facial muscle weakness but will have other associated problems such as arm or leg weakness or problems with vision or speech. Bell's palsy can cause slurred speech since it weakens the muscles but should not affect the ability think of or understand speech. Bell's palsy is much more common than stroke in a person younger than 60 years old.

The most common complication of Bell's palsy is ulceration of the cornea of the eye due to dryness. Often people with Bell's palsy cannot close their eye, causing the eye to dry out and damage the cornea. Preventative care with frequent artificial tear drops in the daytime and thicker lubricating ointment at bedtime is essential. If you cannot close the eye, you should either patch the eye or scotch tape the eye closed by taping the upper lid down to the cheek at bedtime to prevent the eyelids from opening overnight. Follow up with your doctor immediately if you develop eye pain or blurry vision.

About 85 percent of people with Bell's palsy recover completely within a few months, with or without medical treatment. Complete recovery is more likely if you show signs of some improvement within the first three weeks. Recovery can take as long as three to six months and sometimes more than a year. If recovery has not started by three months, there is a higher chance you will have some residual nerve and muscle weakness. Ten percent to 15 percent of people may have partial recovery and a few percent have complete paralysis of those facial muscles. Occasionally, facial nerve damage causes persistent problems with abnormal tears or salivation because the nerve controls these functions, as well.

Doctors are not sure that any treatment hastens nerve recovery or changes the ultimate outcome of Bell's palsy. Medical studies have been limited. Steroid pills such as prednisone may decrease the swelling of the nerve. Recently, antiviral pills such as Acylcovir have been used since oral herpes virus (which causes cold sores) may contribute to facial nerve swelling. If these medications are to be used, they should be taken within the first several days.

No initial exercises or massage have been shown to be helpful. If people have residual problems after three months, exercises may help to relearn facial expressions as the nerve slowly regenerates.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, January 28, 2003