Bell’s Palsy

Diagnosis

There is no single test for Bell’s palsy. Diagnosis primarily relies on a clinical examination:

• Facial assessment: Your healthcare professional will observe your ability to move facial muscles, including closing your eyes, lifting your eyebrows, frowning, and smiling.

• Medical history: The doctor will ask about the onset of symptoms, prior infections, recent illnesses, and risk factors.

Other conditions can mimic Bell’s palsy, such as stroke, infections, Lyme disease, tumors, or inflammatory disorders. Additional tests may be recommended if the cause is uncertain:

• Electromyography (EMG): Confirms nerve damage, measures severity, and assesses electrical conduction along the facial nerve.

• Imaging scans: MRI or CT scans help rule out tumors, skull fractures, or other sources of nerve compression.

• Blood tests: While no blood test can diagnose Bell’s palsy, tests can rule out infections like Lyme disease.

Treatment

Most people with Bell’s palsy recover fully, with or without treatment. Management aims to reduce nerve inflammation, protect the eye, and prevent permanent muscle shortening.

Eye Care

Because the affected eye may not close properly:

• Lubricating eye drops: Used during the day to keep the eye moist.

• Ointments: Applied at night for continuous moisture.

• Protection: Wear glasses or goggles during the day and an eye patch at night to prevent injury. Regular monitoring by a healthcare professional may be needed.

Medicines

• Corticosteroids: Prednisone and similar steroids reduce facial nerve swelling, improving the chances of full recovery, especially when started within days of symptom onset.

• Antiviral drugs: Medications such as valacyclovir (Valtrex) or acyclovir may sometimes be prescribed alongside steroids for severe cases, though evidence of benefit is limited.

Physical Therapy

• Facial exercises and massage: Help prevent muscle shortening, maintain mobility, and improve symmetry during recovery.

• Physical therapy is important to prevent long-term muscle stiffness or weakness.

Surgery

• Decompression surgery: Previously used to relieve nerve pressure, but now rarely recommended due to risks of nerve injury and hearing loss.

• Facial reanimation surgery: In rare cases with lasting weakness, procedures like eyebrow lifts, eyelid lifts, facial implants, or nerve grafts can restore appearance and function. Some surgeries may require repeat procedures after several years.