Bell's Palsy
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Bell's palsy is a condition that causes sudden weakness or paralysis (inability to move) on one side of the face. It happens when the nerve that controls your facial muscles becomes inflamed (swollen). This is not a stroke, and most people recover fully over weeks to months.
Key facts
- Bell's palsy can happen to anyone, but it is most common between ages 15 and 60.
- Symptoms usually appear suddenly, often overnight, and peak within 48 hours.
- About 70–80% of people recover completely, often within 3 to 6 months, even without treatment.
Yes, Bell's palsy is relatively common. It affects about 1 in 60 people at some point in their lives.
Anyone can get Bell's palsy, but it is more common in pregnant women, people with diabetes, and those with compromised immune systems.
Symptoms
- Sudden drooping of the face, arm weakness, and trouble speaking or understanding speech (could be a stroke and needs immediate medical help)
- Sudden severe headache with facial weakness
- Loss of consciousness or seizure
- ⚠Sudden facial weakness or drooping that comes on over a few hours (even if no other stroke symptoms, call your doctor or go to urgent care the same day to rule out a stroke)
- ⚠Inability to close your eye completely, leading to pain, redness, or vision changes
- ⚠New symptoms that get worse after two days
Common symptoms
- Sudden weakness or drooping on one side of your face, making it hard to smile or close your eye
- Loss of ability to wrinkle your forehead on that side
- Drooping of the corner of your mouth
- Pain around the jaw or behind your ear on the affected side
- Increased sensitivity to sound in one ear
- Change in taste, such as food tasting different or less flavourful
- Difficulty with eating and drinking because food falls out of your mouth
Symptoms in children
- Children may experience facial drooping that parents notice when they smile or cry.
- They might complain of ear pain or headache.
- Some children have trouble closing their eye completely, leading to dry eyes or irritation.
Symptoms in older adults
- Older adults may have more severe symptoms or take longer to recover.
- They might confuse the symptoms with a stroke, so it is important to get checked immediately.
- Other health conditions like diabetes or high blood pressure can affect recovery.
Causes
Main causes
- The exact cause is often unknown, but many cases are linked to a viral infection, such as the herpes simplex virus (the same virus that causes cold sores).
- Inflammation and swelling of the facial nerve (the nerve that controls your facial muscles) is what leads to the symptoms.
Risk factors
- Pregnancy, especially during the third trimester or first week after childbirth
- Having diabetes, high blood pressure, or obesity
- A weakened immune system (from stress, lack of sleep, or illnesses like colds and flu)
- Family history of Bell's palsy (slightly higher risk)
- Recent infection or illness
When to see a doctor
See a doctor urgently if:
- Seek same-day care (or call emergency services if you also have trouble moving your arm or speaking) as soon as you notice facial drooping or weakness.
- Go to an emergency room or urgent care immediately if you cannot close your eye, have severe pain, or your symptoms get worse quickly.
Book a routine appointment if:
- If your symptoms are mild (for example, slight weakness but you can still close your eye and eat normally), make an appointment with your doctor within a few days.
- See your doctor if you have not recovered within a few months, or if new symptoms appear (like twitching or unwanted facial movements).
Diagnosis
Your doctor will diagnose Bell's palsy mainly by examining your face and asking about your symptoms. They will check if the weakness involves just your face (and not your arms or legs), which helps rule out a stroke. There is no single test for Bell's palsy, but your doctor may do some tests to rule out other causes.
Tests that may be done
- A physical exam to see which parts of your face are affected
- Blood tests (for example, to check for infections like Lyme disease)
- Imaging tests like an MRI or CT scan (only if the diagnosis is unclear or symptoms are unusual)
- Electromyography (EMG) to measure the electrical activity of your facial nerve (rarely needed)
What to expect at your appointment
If your doctor suspects Bell's palsy, they will explain the condition and discuss treatment options. Most people are evaluated in the office and do not need to be admitted to the hospital. They will also give you advice on protecting your eye and managing symptoms at home.
Treatment
Treatment for Bell's palsy focuses on speeding up recovery and preventing complications like eye damage. Many people get better on their own, but medications and self-care can help.
Self-care at home
- Protect your eye on the affected side: use lubricating eye drops during the day and an eye ointment at night, and wear an eye patch or tape your eyelid shut while sleeping.
- Gently massage your face with your fingers in an upward motion to help relax muscles.
- Do facial exercises (like raising your eyebrows, smiling, and puffing your cheeks) as recommended by a physiotherapist or doctor.
- Eat soft foods and chew slowly to avoid choking.
- Rest as much as you can and avoid stress.
Medical treatments
Doctors often prescribe a course of corticosteroid medications (like prednisone) to reduce swelling of the facial nerve, which may improve recovery if started within 72 hours of symptoms. Antiviral medications may be added in some cases, especially if a viral infection is thought to be the cause. Pain relievers can help with any ear or jaw pain. Always follow your doctor's advice. Do not take over-the-counter medications without consulting a healthcare provider.
When is surgery considered?
Surgery is rarely needed for Bell's palsy. In very severe cases where the nerve is severely compressed, some surgeons may consider decompression surgery, but this is not common and carries risks. Most experts recommend avoiding surgery because the benefits are unclear.
Living with this condition
Living with Bell's palsy can be frustrating, especially at first. You may have trouble eating, drinking, or speaking clearly. You cannot control one side of your face, which can affect your facial expressions and make you feel self-conscious. Most symptoms improve over a few weeks, and many people are back to normal within three months.
Lifestyle tips
- Protect your eye every day, especially from wind, dust, and bright sunlight – wear sunglasses or a hat when outside.
- Use a straw for drinking liquids to avoid spills.
- Try facial exercises in front of a mirror to help retrain your muscles.
- Rest when you feel tired, and avoid pushing yourself too hard.
- Tell people about your condition so they understand why your face looks different.
Diet and exercise
Eat a balanced diet with plenty of fruits, vegetables, and protein to support nerve healing. Soft foods like yogurt, soup, and mashed potatoes may be easier to eat. Chew on the unaffected side of your mouth. Avoid very hot or hard foods that could injure your mouth. Gentle exercise like walking is fine, but avoid heavy lifting or straining until your face feels stronger.
Mental health and emotional wellbeing
Bell's palsy can affect your emotional well-being. You may feel embarrassed, frustrated, or anxious about your appearance and recovery. This is normal. Talk to friends, family, or a counsellor about your feelings. Remember that most people recover, and your facial expressions will return in time. If you feel depressed or overwhelmed, speak to your doctor – they can connect you with support services.
Prevention
Currently, there is no proven way to prevent Bell's palsy because the exact cause is often unknown. However, living a healthy lifestyle – managing stress, getting enough sleep, eating well, and avoiding infections – may lower your risk.
Vaccines
There is no specific vaccine to prevent Bell's palsy. However, staying up to date with vaccines that prevent infections (such as the flu vaccine and COVID-19 vaccine) may help reduce the risk of viral illnesses that could potentially trigger it.
Complications
If left untreated
- Incomplete recovery – some people may have permanent mild facial weakness or asymmetry.
- Damage to the cornea (the clear covering of the eye) from dryness or scratching if the eye is not properly protected.
- Synkinesis: when facial nerves regrow incorrectly, causing unwanted movements, like your eye closing when you smile.
- Chronic pain or tics (involuntary muscle movements) in rare cases.
Long-term outlook
The outlook for Bell's palsy is very good. Most people begin to improve within 2 to 3 weeks and fully recover within 3 to 6 months. Even if recovery is not complete, the remaining symptoms are usually mild and manageable. With proper eye care and emotional support, people with Bell's palsy can live normally and regain their quality of life.
Find support
International organisations
Local organisations
- NHS Inform (Scotland) - Bell's Palsy ↗ · UK (Scotland)
Helplines
External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.
Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.