Bell's Palsy

Facial Paralysis Due to Bell’s Palsy

Bell’s palsy is the most common, and usually temporary, cause of one-sided facial paralysis. The paralysis typically occurs suddenly (over 3 days or less) and may cause limited or full paralysis of the affected side of the face. Commonly, it will present with ear pain, changes in hearing, facial numbness, limited eye closure, and dryness of the ear. The most notable outward symptoms include limitations in facial expression, speech, vision, eating and drinking. Many patients will rush to the emergency room at the onset of Bell’s palsy symptoms, thinking they are having a stroke.


Your health is important. Don’t delay care.

If you experience any symptoms of facial paralysis, you should immediately seek medical help. To schedule an in-person consultation with a UH facial paralysis expert, call 216-844-3223.
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Diagnosis and Treatment for Bell’s Palsy

The precise cause of facial paralysis in Bell’s palsy is unknown. Some studies suggest, however, that it is due to swelling and constriction of the facial nerve as it passes through the skull, possibly as the result of a reactivated virus within the nerve. Regardless of the cause, evaluation by a medical team is the appropriate next step in any case of facial paralysis to ensure the proper diagnosis and treatment.

If a physical exam and medical history do not reveal any obvious reason for sudden, one-sided facial paralysis, the condition may be diagnosed as Bell’s palsy. Typically the first treatment will be to start the patient on a course of steroids to help reduce the swelling that is constricting the nerve. If eyelid function is affected, making complete eye closure impossible, the patient will also be prescribed an eye lubricant that should be used until the eyelid function fully resumes. To ensure the cornea remains healthy, the treating physician may refer the patient to an eye specialist (ophthalmologist) for examination and ongoing care. Severe cases of facial paralysis may prompt surgical decompression of the nerve by a specialist in order to improve the recovery of the nerve. Consideration for decompression requires prompt evaluation within the first few weeks of the initial onset of paralysis.

Recovery and Prognosis

The prognosis for recovery of facial function with Bell’s palsy is good, with most people experiencing a complete recovery within 3-6 weeks. However, for some patients, complete recovery can take 3-4 months and still others (approximately 20 percent) will experience an incomplete recovery in which some abnormal facial movements persist after recovery. Delayed recovery may prompt work up for other causes of facial paralysis which may go undiagnosed for long periods of time.

Symptoms of an incomplete recovery may include:

  • Tightness around the eye, mouth and/or neck
  • Synkinesis – abnormal coordination of the facial muscles. An example of this would be eye closure with mouth movement or vice versa.

Therapy for these conditions may include:

  • Physical therapy with facial massage and facial muscle retraining
  • Botulinum toxin (Botox®) therapy to restore facial symmetry and balance
  • Surgical procedures to remove or reroute nerves or muscles that are not functioning correctly