Imagine waking up one morning and realizing that one side of your face doesn’t move the way it used to. You try to smile, but only half of your mouth responds. You attempt to blink, but your eye doesn’t close completely. It’s a sudden, confusing experience that leaves you feeling alarmed and unsure of what’s happening.
This was my reality a few years ago. I remember waking up to an unsettling discomfort around my ear and noticing that the left side of my face felt different. At first, I dismissed it as fatigue or stress, but as the hours passed, the discomfort turned into weakness.
I called my mother, panicking and explaining how I couldn’t fully move my face. She suggested I make a video call so she could see what was happening. As I tried to smile, my reflection on the screen of my phone revealed the frightening truth—one side of my face was drooping. My mother immediately urged me to go to the hospital, fearing it might be something serious, like a stroke!
I was terrified. The thought of dealing with something so sudden and severe felt overwhelming. At the hospital, the doctor examined me carefully and ruled out a stroke. Instead, I was diagnosed with something I’ve never heard of before: Bell’s palsy.
At first, I didn’t understand. What was Bell’s palsy? Why did it look so severe? Was it life-threatening? As I began my journey toward recovery, I learned more about this condition, its causes, and how it’s often misunderstood.
In this article, I’ll share what I learned about Bell’s palsy, its causes, and its treatment.
My hope is that this information will bring awareness, clarity, and comfort to anyone who is currently facing or may face a similar situation.
Man with facial asymmetry caused by Bell's palsy, showing one side drooping and the other unaffected. Photo credit- Pexels.com
Prevalence Rate Of Bell’s Palsy
Although not a widely discussed condition, Bell’s palsy is more common than many might think, affecting approximately 40,000 people in the United States each year, and its global incidence rate is estimated to be 11–40 cases per 100,000 people annually.[4]
While the condition can impact individuals of all ages, certain groups are at a higher risk:
Age: Most commonly affects individuals between 15 and 45 years old, but it can occur at any age.
Gender: Men and women are equally likely to develop Bell’s palsy.
Pregnancy: Pregnant women are about 3 times more likely to develop Bell’s palsy, particularly in the third trimester or immediately postpartum.
Diabetes: People with diabetes are at 4–5 times higher risk compared to the general population.
Family History: Those with a family history of Bell’s palsy may have a slightly elevated risk.
These statistics emphasize that Bell’s palsy is more common than many realize and can affect a wide range of people. Knowing this can help reduce the stigma and foster empathy for those experiencing this condition.[1]
By placing these figures into perspective, we can better understand how Bell’s palsy impacts different demographics and spread awareness of this often-misunderstood condition.
What is Bell’s Palsy?
Bell’s palsy is a condition that causes sudden weakness or paralysis on one side of the face. This happens when the 7th cranial nerve which is responsible for controlling facial expressions becomes inflamed, swollen, or compressed.
This condition can affect anyone, regardless of age or gender. Although it may look severe, Bell’s palsy is usually temporary, and most people recover fully within a few weeks or months.
How is Bell’s Palsy Different from Stroke
One of the biggest misconceptions about Bell’s palsy is that it’s a type of stroke. The two conditions may share similar symptoms, like facial weakness or drooping, but they are very different.[1]
The table below provides a side-by-side comparison of the two conditions based on key parameters.
Parameter | Bell’s Palsy | Stroke |
Affected Area | Facial nerve (7th cranial nerve), leading to weakness or paralysis on one side of the face. | Brain tissue, potentially affecting various body functions depending on the affected brain region. |
Cause | Inflammation or viral infection affecting the facial nerve. | Blood clot (ischemic stroke) or ruptured blood vessel (hemorrhagic stroke) disrupting blood flow to the brain. |
Symptoms | Sudden facial weakness or paralysis; drooping eyelid or corner of the mouth; difficulty closing one eye; loss of taste on the front two-thirds of the tongue. | Weakness or paralysis on one side of the body, including the face; impaired vision, speech difficulties, loss of balance, or numbness[1]. |
Duration | Temporary; most recover fully within weeks to months. | May cause permanent damage without immediate treatment. |
Recovery | High likelihood of full recovery. | Recovery depends on the severity and timely medical care; some effects may be permanent. |
Risk Factors | Viral infections, diabetes, pregnancy, or family history of Bell’s palsy. | High blood pressure, smoking, obesity, diabetes, high cholesterol, atrial fibrillation, and advanced age. |
Table 1: Table comparing Bell’s palsy and stroke: causes, symptoms, treatment, risk factors, and recovery.
Diagram explaining facial palsy causes, symptoms, and differences between stroke and Bell’s palsy. Photo credit- Pexels.com
If you or someone you know develops sudden facial weakness, it’s critical to seek medical attention immediately to rule out a stroke. Once a doctor confirms Bell’s palsy, you can take comfort knowing it’s not life-threatening and has a high chance of recovery.
What Causes Bell’s Palsy?
Bell’s palsy is believed to occur when the facial nerve, responsible for controlling muscles on one side of your face, becomes inflamed.
While the exact cause isn’t fully known, research suggests that viral infections are a major trigger. Here's a closer look at how the condition develops:
Viral Infections and the Immune Response
The facial nerve travels through a narrow passageway in the skull near the ear, and when it becomes inflamed, it can compress, leading to paralysis.
This compression disrupts the nerve’s ability to transmit signals to the muscles of the face, leading to weakness or paralysis. Viral infections are thought to cause this inflammation.
Specifically, viruses can infect the nerve, triggering the immune system to react in a way that leads to inflammation. The immune system's response can also cause swelling of the nerve, which results in its compression.
Common Viruses Linked to Bell’s Palsy
Several viral infections have been associated with Bell’s palsy. The most common ones include:
Herpes simplex virus (HSV): The same virus responsible for cold sores around the mouth is a major contributor to Bell’s palsy. HSV can become dormant in the body and reactivate later, leading to facial nerve inflammation.[3]
Varicella-zoster virus (VZV): This is the virus responsible for chickenpox in children and shingles in adults. After a person recovers from chickenpox, the virus can remain dormant in the body and reactivate years later, leading to shingles and potentially Bell’s palsy.
Epstein-Barr virus (EBV): EBV causes mononucleosis and lymphoma and is known to affect the immune system. The virus has been linked to a variety of conditions, including Bell’s palsy, because it can lead to inflammation of the facial nerve.
Influenza viruses: The seasonal flu and other related viruses can also trigger Bell’s palsy in some individuals. These viruses can lead to viral infections that inflame the facial nerve.[3]
Other Risk Factors
While viral infections are a major cause of Bell’s palsy, several other factors can contribute to or increase the risk of developing the condition:
Stress or Weakened Immunity: Chronic stress, a lack of sleep, and other factors that weaken the immune system may make the body more susceptible to viral infections. The body’s immune system can be less efficient at managing the infection, leading to inflammation and potential nerve damage.
Diabetes: Individuals with diabetes are more likely to develop Bell’s palsy. The condition is believed to affect the body’s ability to regulate blood sugar levels, which can impair the immune system. In addition, diabetes is linked to a higher risk of nerve damage, which may make the facial nerve more vulnerable to inflammation.[3]
Pregnancy (Especially in the Third Trimester): Pregnant women, particularly in the later stages of pregnancy, have an increased risk of Bell’s palsy. This may be due to hormonal changes that can affect the immune system, as well as the physical stress of pregnancy. Hormones like progesterone and estrogen can influence immune responses and make pregnant women more susceptible to infections that might cause Bell’s palsy.[3]
Genetics and Family History: There’s some evidence to suggest that genetics might play a role. People with a family history of Bell’s palsy may have a slightly higher risk, although this is not a guaranteed factor.
Symptoms of Bell’s Palsy
Bell’s palsy typically appears quite suddenly, developing within 48 to 72 hours, and generally improves over the course of a few weeks. The symptoms can be alarming, especially since they can affect basic facial functions like smiling, blinking, and speaking.[2]
Infographic on Bell’s Palsy showing symptoms, risk factors, and treatment options. Photo Credit- Pexels.com
Here's a closer look at some of the key signs to watch for:
Weakness or Paralysis on One Side of the Face
The highlight of Bell’s palsy is sudden weakness or complete paralysis on one side of the face. This often affects the muscles that control facial expressions, making one side of the face droop or appear less mobile than the other.
A Drooping Mouth or Difficulty Smiling
A common sign of Bell’s palsy is a drooping mouth, which makes it difficult to smile or show facial expressions on one side. This can create an uneven or asymmetrical appearance, which is one of the first things people may notice.[2]
Inability to Close One Eye Completely
Another classic symptom is an inability to close one eye properly. The eye on the affected side may stay open, even when trying to blink or close it. This can lead to irritation or dryness, as the eyelid may not be able to fully protect the eye.[2]
Excessive Tearing or Dryness in the Affected Eye
Due to the inability to blink properly, people with Bell’s palsy may experience excessive tearing or, conversely, a feeling of dryness in the affected eye. The eye may not be able to produce or spread tears as effectively, leading to discomfort.
Sensitivity to Sound in One Ear
In some cases, people with Bell’s palsy experience heightened sensitivity to sound in one ear. This condition, known as hyperacusis, can cause everyday noises to sound louder or more uncomfortable than usual.
Difficulty Eating, Drinking, or Speaking Clearly
The weakness on one side of the face can also make it hard to chew, drink, or speak normally. People might struggle to keep food or liquid in their mouth or speak clearly due to the lack of muscle control in the affected area.
Although these symptoms can feel frightening, it’s important to remember that Bell’s palsy is typically a temporary condition. Most people start to see improvement within a few weeks, and full recovery often happens within 3 to 6 months. If you experience these symptoms, it’s important to seek medical attention promptly to confirm the diagnosis and begin appropriate treatment.
How to Diagnose Bell’s Palsy
Diagnosing Bell’s palsy can be a bit tricky since there is no specific test for it. Instead, doctors rely on ruling out other potential conditions that could be causing similar symptoms, such as a stroke, Lyme disease, or tumors.[6]
Doctors may carry out diagnosis in the following ways:
Physical Exam
The doctor will conduct a thorough physical examination to assess the strength and movement of the facial muscles. They’ll look for signs of asymmetry, such as a drooping mouth or inability to raise an eyebrow, which helps confirm the presence of Bell’s palsy.[6]
Imaging Tests (MRI or CT scan)
In some cases, doctors may order imaging tests, such as an MRI or CT scan, to ensure there are no underlying issues, like a tumor or other structural abnormalities, that might be causing the symptoms.
Medical History Review
Your doctor will ask about your medical history, including any recent viral infections, trauma, or other health conditions. This helps them assess if there are any contributing factors, like an existing viral infection or stress.
While Bell’s palsy can be concerning, prompt diagnosis helps in getting the right treatment started early, leading to a better recovery outcome.
Treatment and Recovery Of Bell’s Palsy
Most people with Bell’s palsy recover fully, typically within 3 to 6 months, although the timeline can vary.[5]
The following treatments are commonly used to manage the condition.
Medications
Corticosteroids: These are the first line of treatment and help reduce inflammation around the facial nerve. They work most effectively when taken within the first 48 to 72 hours after symptoms appear. [2]
Antiviral Medications: If a viral infection is suspected (such as the herpes simplex virus), doctors may prescribe antiviral drugs, though their effectiveness for Bell’s palsy is still debated.
Protecting the Eye
One of the main challenges of Bell’s palsy is the inability to fully close the affected eye, which can lead to dryness or injury. To protect the eye:
Lubricating Eye Drops: These can be used during the day to keep the eye moist and comfortable.
Eye Ointment at Night: For added protection, an eye ointment can help prevent dryness while sleeping.
Eye Patch or Taping the Eyelid: Wearing an eye patch or taping the eyelid shut at night helps prevent the eye from drying out or being injured while you sleep.
Physical Therapy
Facial exercises, massages and acupuncture are sometimes recommended to help improve muscle strength and reduce stiffness. These should be done under the supervision of a healthcare professional to ensure they are done correctly and safely.
Lifestyle Adjustments
Healing from Bell’s palsy takes time, so focusing on rest and reducing stress is essential. During recovery, you might need to:
Stick to Soft Foods: If chewing or eating becomes difficult, go for soft foods to make eating easier.
Be Patient: Nerve healing can take time, and recovery may vary. It’s important to give your body the time it needs to heal, even if progress feels slow at times.
Facial Surgery
For severe cases of Bell’s palsy where facial nerve function does not recover fully, surgery can help restore aesthetic balance and functional abilities.[6] Surgical interventions include:
Facial Nerve Grafting: Nerve grafts, such as the sural nerve, can be used to restore muscle function by reconnecting damaged facial nerves.
Eyebrow Lift or Blepharoplasty: To improve the appearance of drooping eyebrows or correct incomplete eyelid closure.
Botox Injections: Botox can be used to relax overactive muscles on the unaffected side of the face, restoring balance and symmetry. It can also help reduce synkinesis (involuntary movements that occur alongside voluntary ones).[6]
Facial Reanimation Surgery: This involves transferring muscles, such as the gracilis muscle from the thigh, to restore facial movement.
While surgical interventions are not always necessary, they can provide significant improvements in both function and confidence for those with long-term effects of Bell’s palsy. Bell’s palsy is usually temporary, but it is important to note that if not treated properly, it can lead to permanent facial paralysis.[3]
If you or someone you know has severe or prolonged symptoms, it’s important to consult with a specialist to determine the most suitable treatment options.
Coping with the Emotional Impact Of Bell’s Palsy
Dealing with Bell’s palsy wasn’t just physically challenging for me–it was an emotional battle as well. The sudden changes to my appearance hit me harder than I expected. Every time I looked in the mirror, I felt a pang of sadness. My smile, something I had always taken for granted, was now unrecognizable.
The hardest part was facing other people. I worried about how they would react to my face. Would they notice? Would they judge me? Simple interactions, like speaking or laughing, became stressful. I felt self-conscious about the way my mouth moved or didn’t and avoided social gatherings for fear of being misunderstood or stared at.
There were days when the emotional weight felt unbearable. I called my mother often, confiding in her about my fears and frustrations. She became my biggest source of strength, reminding me that my condition was temporary and didn’t define who I was. Her encouragement helped me shift my focus from what I’d lost to what I still had.
Through this journey, I learned the importance of self-compassion. I had to remind myself that it was okay to feel upset or frustrated and that recovery wouldn’t happen overnight. I started celebrating small victories, like being able to close my eyes a little more or noticing a twitch in my cheek that hadn’t been there before.
Having a support system made all the difference. My mother, friends, and loved ones reminded me that I wasn’t alone. They treated me with kindness and patience, which helped me rebuild my confidence.
This experience taught me that healing is not just about physical recovery—it’s about emotional resilience too. Yes, Bell’s palsy changed my face for a time, but it didn’t change who I was at my core. It reminded me of my strength and the power of perspective.
If you’re dealing with Bell’s palsy, know that it’s okay to have difficult days. Give yourself grace and allow time to heal. You’re not defined by this temporary condition, and with the right care and support, you’ll come out stronger on the other side.
If this article helped you better understand Bell’s palsy, feel free to share your thoughts, leave a comment, or pass it along to someone who might benefit. Together, let’s spread awareness and offer support to those facing this journey!
References
Centers for Disease Control and Prevention. (2022). Bell's palsy. Retrieved from https://www.cdc.gov
National Institute of Neurological Disorders and Stroke. (2023). Bell’s palsy fact sheet. Retrieved from https://www.ninds.nih.gov
Mayo Clinic. (2023). Bell’s palsy. Retrieved from https://www.mayoclinic.org
Holland, N. J., & Weiner, G. M. (2004). Recent developments in Bell’s palsy. BMJ, 329(7465), 553–557. https://doi.org/10.1136/bmj.329.7465.553
Peitersen, E. (2002). Bell's palsy: The spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto-Laryngologica. Supplementum, 549, 4–30. https://doi.org/10.1080/000164802760370736
Rosenberg, J. (n.d.). Causes and symptoms of Bell’s palsy. Retrieved December 19, 2024, from https://www.drjoshuarosenberg.com/blog/causes-and-symptoms-of-bells-palsy/ Assessed and Endorsed by the MedReport Medical Review Board