Bell's PalsySymptoms, Doctors, Treatments, Advances & More
Learn About Bell's Palsy
Bell palsy is a disorder of the nerve that controls movement of the muscles in the face. This nerve is called the facial or seventh cranial nerve.
Damage to this nerve causes weakness or paralysis of these muscles. Paralysis means that you cannot use the muscles at all.
Facial palsy; Idiopathic peripheral facial palsy; Cranial mononeuropathy - Bell palsy; Bell's palsy
Bell palsy can affect people of any age, most commonly those over age 65 years. It can also affect children younger than 10 years. Males and females are equally affected.
Bell palsy is thought to be due to swelling (inflammation) of the facial nerve in the area where it travels through the bones of the skull. This nerve controls movement of the muscles of the face.
The cause is often not clear. A type of herpes infection called herpes simplex or herpes zoster might be involved. Other conditions that may affect the seventh cranial nerve include:
- HIV/AIDS infection
- Lyme disease
- Middle ear infection
- Sarcoidosis (inflammation of the lymph nodes, lungs, liver, eyes, skin, or other tissues)
Having diabetes and being pregnant may increase the risk for Bell palsy.
Sometimes, you may have a cold shortly before the symptoms of Bell palsy begin.
Symptoms most often start suddenly, but may take 2 to 3 days to become fully developed. They do not become more severe after that.
Symptoms are almost always on one side of the face only. They may range from mild to severe.
Many people feel discomfort behind the ear before weakness is noticed. The face feels stiff or pulled to one side and may look different. Other signs can include:
- Difficulty closing one eye
- Difficulty eating and drinking because food falls out of one side of the mouth
- Drooling due to lack of control over the muscles of the face
- Slurring your words (dysarthria) due to lip weakness
- Drooping of the face, such as the eyelid or corner of the mouth
- Problems smiling, grimacing, or making facial expressions
- Twitching or weakness of the muscles in the face
Other symptoms that may occur:
- Dry eye, which may lead to eye sores or infections
- Dry mouth
- Headache if there is an infection such as Lyme disease
- Loss of sense of taste
- Sound that is louder in one ear (hyperacusis)
Often, no treatment is needed. Symptoms often begin to improve right away. But, it may take weeks or even months for the muscles to get stronger.
Your provider may give you lubricating eye drops or eye ointments to keep the surface of the eye moist if you can't close it completely. You may need to wear an eye patch while you sleep.
Often, medicines may be used to improve the chances of recovery, but they must be started right away. Common medicines are:
- Corticosteroids, which may reduce swelling around the facial nerve
- Medicines such as valacyclovir to fight the virus that may be causing Bell palsy
Surgery to relieve pressure on the nerve (decompression surgery) has not been shown to benefit most people with Bell palsy.
Johns Hopkins Outpatient Center
Dr. Kofi Derek Owusu Boahene is a professor of otolaryngology-head and neck surgery and dermatology at the Johns Hopkins University School of Medicine. He is the Director of the Division of Facial Plastics and Reconstructive Surgery and the director for the facial plastics fellowship training program. His practice encompasses the entire spectrum of facial plastic and reconstructive surgery including cosmetic and reconstructive aspects. Dr. Boahene is a leading expert in facial paralysis surgery and facial nerve injuries and has pioneered innovative treatment protocols and surgical techniques in facial reanimation. He is the director of the Johns Hopkins Facial Nerve center dedicated to restoring facial balance, symmetry and animation to those who have suffered from facial paralysis and facial nerve disorders. As an expert microsurgeon, Dr. Boahene routinely performs some of the most complex facial reconstruction procedures on the face including rebuilding of an entire nose, lip, jaw and facial defects resulting from cancer treatment, traumatic injuries or as a result of birth defects. He uses cutting edge 3-D technology, image-guided technology and tissue transplanted from other parts of the body to restore or replace missing tissues. He is a key member of the Johns Hopkins facial transplant program. His cosmetic experience is broad and draws from patients across the globe. He routinely performs rhinoplasties, eyelid surgery, face lifts and other facial enhancing procedures. As a skull base surgeon, Dr. Boahene has pioneered minimally invasive techniques for removal of skull base and brain tumors, repairing CSF leaks and has authored a major textbook on this subject. Dr. Boahene received his undergraduate degree from the University of Central Arkansas. He graduated summa cum laude from Meharry Medical College in Nashville, Tennessee, completed a five-year surgical residency training program in otolaryngology-head and neck surgery at the Mayo Clinic in Rochester, Minnesota, and received fellowship training in facial plastic and reconstructive surgery at the University of Minnesota. As the recipient of the prestigious Mayo Brothers Distinguished Fellowship Award, Dr. Boahene was awarded additional craniofacial surgery training in Adelaide, Australia. He also received the Jack R. Anderson Prize for Scholastic Excellence for attaining the highest score nationally on the American Academy of Facial Plastic and Reconstructive Surgery certification exam. Dr. Boahene serves as on the Board of Governors or the American Academy Facial Plastic and Reconstructive Surgery. He is a member of several professional organizations, including the American Academy of Facial Plastic and Reconstructive Surgery and the American Academy of Otolaryngology-Head and Neck Surgery. In 1993, Dr. Kofi Boahene received the Alpha Omega Alpha Medical. Dr. Boahene is rated as an Elite provider by MediFind in the treatment of Bell's Palsy. His top areas of expertise are Facial Paralysis, Bell's Palsy, Recurrent Peripheral Facial Palsy, Septoplasty, and Gastrostomy.
Shin-ichi Haginomori practices in Takatsuki, Japan. Mr. Haginomori is rated as an Elite expert by MediFind in the treatment of Bell's Palsy. His top areas of expertise are Bell's Palsy, Facial Paralysis, Herpes Zoster Oticus, Salivary Gland Tumors, and Mastoidectomy.
Franz Babl practices in Parkville, Australia. Mr. Babl is rated as an Elite expert by MediFind in the treatment of Bell's Palsy. His top areas of expertise are Bell's Palsy, Cellulitis, Bronchitis, and Febrile Neutropenia.
Most cases go away completely within a few weeks to months.
If you did not lose all of your nerve function and symptoms began to improve within 3 weeks, you are more likely to regain all or most of the strength in your facial muscles.
Sometimes, the following symptoms may still be present:
- Long-term changes in taste
- Spasms of muscles or eyelids
- Weakness that remains in facial muscles
Complications may include:
- Eye surface becoming dry, leading to eye sores, infections, and vision loss
- Swelling in the muscles due to loss of nerve function
Contact your provider right away if your face droops or you have other symptoms of Bell palsy. Your provider can rule out other, more serious conditions, such as stroke.
There is no known way to prevent Bell palsy.
Summary: Bell's palsy, a peripheral facial nerve paresis, is the most common disorder of the facial nerve and one of the most common mononeuropathies. Many patients with Bell's palsy will develop some complications such as synkinesis, crocodile tears and 'sweating' of the ear while eating Commonly used medications to treat Bell's palsy is Corticosteroids Cerebrolysin stimulates the regeneration of the nerv...
Summary: The eyelids protect the cornea and eyelid closure is essential to ocular health and clear vision. Patients with permanent Bells palsy or facial nerve palsy from other reasons such as tumours or trauma may be unable to blink and protect their cornea. Irreversible visual loss can occur if the cornea is not kept lubricated. Current treatment options for patients whose eyelid blink does not recover in...
Published Date: June 13, 2024
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
National Institute of Neurological Disorders and Stroke website. Bell's palsy. www.ninds.nih.gov/health-information/disorders/bells-palsy. Updated May 2, 2024. Accessed July 1, 2024.
Ryan MM. Bell palsy. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 657.
Smith G, Shy ME. Peripheral neuropathies. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 388.
Wallenstein J. Brain and cranial nerve disorders. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 91.