Bell's Palsy (Facial Weakness)
Bell's palsy is sudden weakness or paralysis of the muscles on one side of the face, caused by inflammation of the facial nerve. It develops over hours to a day or two, and the cause is usually unknown, though viral infection is thought to play a part. It is more common in pregnancy and in people with diabetes. In Nigeria sudden facial weakness is often called a spiritual attack, or blamed on cold air or a fan, and treated at home or by a traditional healer, which delays the medicines that work best when started early. Most people recover fully within weeks to months. Bell's palsy can only be diagnosed once a doctor has ruled out other causes, above all a stroke.
Medically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Symptoms
- Sudden weakness or drooping of one side of the face, developing over hours to two days
- Difficulty closing the eye on that side
- Drooping of the mouth, with drooling or difficulty keeping food in the mouth
- Loss of the forehead wrinkles on the affected side
- Pain behind the ear before or as the weakness starts
- Changed taste, a dry or watering eye, or sounds seeming louder on that side
When to See a Doctor
See a doctor the same day for any new facial weakness. Steroid tablets work best when started within three days, and only a doctor can confirm it is Bell's palsy. Call for emergency help immediately if facial weakness comes with weakness or numbness of an arm or leg, slurred or confused speech, loss of vision, sudden severe headache, dizziness or loss of balance: these are signs of a stroke. Bell's palsy usually weakens the forehead too, while a stroke usually spares it, but either needs urgent assessment. See a doctor urgently for weakness on both sides of the face, a rash or blisters around the ear, or a painful red eye.
Treatment options
- Steroid tablets started within three days of onset, prescribed by a doctor
- Antiviral medicine in some severe cases, alongside steroids
- Eye protection: lubricating drops by day, ointment and taping the eye closed at night
- Facial physiotherapy: gentle exercises, massage and help with eating and drinking
- Review if there is no improvement after three weeks, or recovery is incomplete after a few months
- Investigation for another cause when the pattern is not typical
What it costs on Mezo
Published cash prices for the treatments used for this condition.
Common Questions
Is Bell's palsy a stroke?
No, but the two can look alike, which is why every new facial weakness needs a doctor the same day. A stroke usually comes with other signs such as arm or leg weakness or slurred speech, but not always. Do not wait to see if it goes away.
Is Bell's palsy a spiritual attack or caused by a fan?
No. It is inflammation of the facial nerve, often linked to a virus. Cold air or a fan does not cause it. Delaying medical treatment to seek other help reduces the chance of a full recovery.
Will my face go back to normal?
Most people recover completely, usually starting within three weeks and finishing within a few months. Starting steroids early improves the chances. A small number are left with some weakness or tightness, which facial physiotherapy can help.
Why do I need to protect my eye?
When the eyelid cannot close properly, the eye dries out and can be scratched or ulcerated, sometimes permanently. Drops by day and ointment with the eye taped shut at night protect it until the eyelid recovers.
Need Help?
Paid online. Assessment and a home exercise programme on the first visit.
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