Diagnosis

There's no specific test for Bell's palsy. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.

Other conditions — such as a stroke, infections, Lyme disease and tumors — can also cause facial muscle weakness, mimicking Bell's palsy. If it's not clear why you're having the symptoms you are, your doctor may recommend other tests, including:

  • Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
  • Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.

Treatment

Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy, but your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.

Medications

Commonly used medications to treat Bell's palsy include:

  • Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they're started within several days of when your symptoms started.
  • Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids are also unlikely to be beneficial.

    However, despite this, valacyclovir (Valtrex) is sometimes given in combination with prednisone in people with severe facial palsy.

Physical therapy

Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery

In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.

In rare cases, plastic surgery may be needed to correct lasting facial nerve problems.

Lifestyle and home remedies

Home treatment may include:

  • Protecting the eye you can't close. Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.
  • Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help ease your pain.
  • Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.
  • Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist's advice may help relax your facial muscles.

Alternative medicine

Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following:

  • Relaxation techniques. Relaxing by using techniques such as meditation and yoga may relieve muscle tension and chronic pain.
  • Acupuncture. Placing thin needles into a specific point in your skin helps stimulate nerves and muscles, which may offer some relief.
  • Biofeedback training. By teaching you to use your thoughts to control your body, you may help gain better control over your facial muscles.
  • Vitamin therapy. Vitamins B-12, B-6 and zinc may help nerve growth.

Preparing for your appointment

You'll likely start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist.

It's good to prepare for your appointment. Here's some information to help you get ready.

What you can do

  • Write down any symptoms you're experiencing. Be sure to include any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information. Have you had any major stresses or life changes recently? Sharing this type of information may help your doctor to make a diagnosis.
  • Make a list of all medications. Include the dosage amount of any medications you're taking, and don't forget to write down any vitamins or supplements that you're taking, too.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions you want to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For Bell's palsy, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Are there any other possible causes for my symptoms?
  • What kinds of tests do I need?
  • Is this condition likely temporary or long lasting?
  • What treatments are available for Bell's palsy? Which do you recommend?
  • Are there alternatives to the primary approach that you're suggesting?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask any additional questions that occur to you during your appointment.

What to expect from your doctor

Be prepared to answer questions from your doctor, such as:

  • When did you begin having symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have any of your relatives ever had Bell's palsy or problems with facial paralysis?
  • Have you had any symptoms of a more generalized infection?

What you can do in the meantime

If you have facial pain:

  • Take over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) can help with pain.
  • Apply moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.

If your eye won't close completely, try these tips:

  • Use your finger to close your eye repeatedly throughout the day.
  • Use lubricating eyedrops.
  • Wear eyeglasses during the day to protect your eye.
  • Wear an eye patch at night.
Dec. 16, 2014
References
  1. Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Nov. 14, 2014.
  2. Glass GE, et al. Bell's palsy: A summary of current evidence and referral algorithm. Family Practice. In press. Accessed Nov. 14, 2014.
  3. Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Nov. 14, 2014.
  4. Bell's palsy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/bells/detail_bells.htm. Accessed Nov. 14, 2014.
  5. Ronthal M. Bell's palsy: Pathogenesis, clinical features, and diagnosis in adults. http://www.uptodate.com/home. Accessed Nov. 15, 2014.
  6. Ronthal M. Bell's palsy: Prognosis and treatment in adults. http://www.uptodate.com/home. Accessed Nov. 15, 2014.
  7. Facial nerve palsy. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/neurologic_disorders/neuro-ophthalmologic_and_cranial_nerve_disorders/facial_nerve_palsy.html?qt=&sc=&alt=. Accessed Nov.16, 2014.
  8. AskMayoExpert. What is the initial therapy recommended for patients with Bell palsy? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.