Bell’s palsy diagnosis and treatment
Bell’s palsy is a diagnosis made by exclusion which means that all other possible causes have been ruled out.
Diagnosis
A doctor will carry out an examination of the nerves which control the head and neck called the cranial nerves. You will be asked to perform a range of facial movements, for example, raising the eyebrows, rounding the lips, closing the eyes, and smiling.
A diagnosis of Bell’s palsy is made if you have, in the space of up to 72 hours, lost the ability to move the affected side of your face or your facial movements are severely disrupted, and you have no other signs or symptoms.
To ensure there are no other signs of disease or illness, other tests may be requested. These might include:
- Blood tests to exclude other causes, such as, Ramsay Hunt Syndrome and Lyme Disease.
- Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT Scan), to exclude tumours
- Tests carried out by specialist clinicians, such as, Ears, Nose and Throat specialists (ENT). This may include a range of hearing tests.
Treatment
The aim of early intervention is to minimise the swelling around the facial nerve in order to stop it being squeezed or compressed.
Steroids
The first line of treatment to help reduce swelling is a course of oral steroids called Prednisolone. To maximise the benefits of steroids they must be given within the first 72 hours of symptoms appearing. There is no evidence of their efficacy if given after this time period.
The current guidelines indicate treatment with a steroid medication called Prednisolone, the optimum dose includes the following two options:
- Prednisolone 50mg daily for 10 days OR
- Prednisolone 60 mg daily for 5 days followed by a daily reduction in dose of 10 mg
Spontaneous recovery will take place with or without the addition of steroids. Steroids simply aid recovery in some instances, but they do not guarantee a full recovery.
Taking oral steroids may improve recovery for some people. For others, the same treatment may not have any benefit. It is not clear why this is the case, but certainly timely treatment with steroids will maximise a person’s potential to recover.
Antivirals
Recent research has shown that antiviral drugs do not improve the outcome for people with Bell’s palsy. Antiviral drugs only benefit those people who have developed a facial palsy secondary to a viral infection, such as Ramsay Hunt Syndrome. Clinical examination will alert the doctor to this potential diagnosis, as commonly there is a rash or blisters in or around the ear, scalp or hairline. Blisters may also appear inside the mouth.
Eye care
Looking after your eye if it is unable to close or blink is extremely important. This is not a treatment for the Bell’s palsy itself, but it is an essential part of the management of your facial weakness or paralysis. Learn more about Eye care.
Self-care
You may be feeling quite low and unwell so allow yourself time to recover. Make sure you rest and perhaps some time off work may be indicated. A healthy balanced diet and plenty of fluids will help maximise your recovery. Remember that the majority of people recover within the first few weeks. Learn more about how facial palsy can affect mental health.
Further treatment
If your recovery does not begin until 2-4 months following the onset of symptoms, the likelihood of incomplete recovery is higher. You should definitely seek help from your GP and ask for a referral to a therapist experienced in the management of facial palsy.
The charity Facial Palsy UK is a useful resource and offers emotional support for those living with facial palsy. Visit www.facialpalsy.org.uk.
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