Bell's Palsy Symptoms Should Be Evaluated

Q:  I was diagnosed with Bell's palsy about 2 months ago. Though it is slowly getting better, I am still worried that I may never fully recover. I still have trouble speaking certain sounds such as the letters f, b, and p (part of the left side of my mouth still feels like I have a novocaine shot in it), my left eyelid doesn't blink 100%, my forehead on the left side doesn't move too much either and my left eye sometimes waters because it is so dry. Is this normal after 2 months?

I also had my facial nerve on my left side tested and it was only functioning at about 4% (I was tested about 1 month ago).

The doctors I have seen and talked to have said that it may take up to 1 full year to fully recover. Is there anything that I can do to help this process? Someone also mentioned the use of steroids. Is that something I should look into or do I just need to be patient and wait for this condition to become better on its own?

Thanks for your time, and any advice in regard to this matter would be greatly appreciated.

A:  Bell’s palsy is a form of facial paralysis resulting from damage to the 7th (facial) cranial nerve. According to the National Institutes of Health, about 40,000 Americans experience this nerve disorder each year. It can strike almost anyone at any age; however, it disproportionately attacks pregnant women and people who have diabetes, influenza, a cold, or some other upper respiratory ailment.

In addition to one-sided facial paralysis with possible inability to close the eye, symptoms of Bell’s palsy may include pain, tearing, drooling, hypersensitivity to sound in the affected ear, and impairment of taste. The common cold sore virus called herpes simplex and other herpes viruses are the likely causes of many cases of Bell’s palsy.

Upon diagnosis, treatment within the first few days with anti-viral medications and steroids will probably improve the recovery. Unfortunately, in your case it is too late to try these options.

Most people with uncomplicated disease will recover within three weeks. It is possible that you have Ramsay-Hunt syndrome rather than Bell's palsy. Ramsay-Hunt is caused by the herpes zoster virus (shingles) and results in more diffuse inflammation of the facial nerve and a slower recovery.

For patients with Bell's palsy who still have severe nerve dysfunction (>95%) after steroid treatment, one study showed better recovery in the patients who had surgical decompression of the nerve. This operation was done within 60 days of the onset of the Bell's palsy.

I strongly recommend that you discuss your situation with an expert in this area. John S. Rhee, MD, Assistant Professor of Otolaryngology and Communication Sciences at the Medical College of Wisconsin and Chief of the Division of Facial Plastic and Reconstructive Surgery specializes in facial plastic surgery and reconstruction. Although surgical decompression of the facial nerve is still controversial, he has seen benefit in patients with poor recovery from Bell's palsy. However, the procedure is not effective in Ramsay-Hunt syndrome.

Dr. Rhee emphasized that protection of your eye is of utmost importance to avoid corneal abrasion and infection. Lubrication with artificial tears, protective covering or even a weighted implant in the eyelid may be necessary to keep it closed.

My advice is not to be patient, but go get evaluated. Sometimes time is crucial.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.