DEAR DR. GOTT: I was diagnosed with Bell’s palsy on the left side of my face six and a half years ago. I was told it was stress-induced and the doctor prescribed prednisone and, I believe ,an anti-inflammatory medication. I took those for about a week to 10 days. It was the only treatment I ever received for the condition.
I knew a little about Bell’s palsy and figured it would clear up in a few months but now, after all this time, it has gotten better but still has not totally resolved.
I have difficulty with the left side of my mouth; it just doesn’t seem to “work” correctly. It is a little difficult to chew on that side and sometimes, when I am speaking mostly, I get a little drool from that side. My left eyelid droops more than my right eyelid (which droops normally from aging and normal skin sagging) and I also have what looks like a “bubble” of skin in the corner of my left eye. When I am very relaxed or tired the left eye closes on its own. Occasionally it will close when I eat or during certain facial expressions.
I know these things will not get better but what I want to find out is what the long-term effects of this condition are. I have not found much information about Bell’s palsy on the web or anywhere else. I have met several people from this same area who have had it or know someone who has had it. The last three places I worked, there have been two or three other people who have had it but theirs cleared up. I was and am still experiencing much stress in my left. Maybe this is why it never cleared up?
I am a 53-year-old female. I take meds for blood pressure, depression and thyroid. (Can certain medications keep it from healing?) I also take vitamins.
I didn’t get much information from the doctor I was going to when I first got the Bell’s palsy and am now concerned about what might happen to my eyelid over time. Will it close completely? This has affected my self-esteem, since my face looks a little off and I can’t even smile. I also wonder why no information is available about this condition since it does not seem to be as rare as I’ve learned. Thank you.
DEAR READER: Bell’s palsy isn’t rare, nor is it common. It affects around 40,000 people a year. It occurs equally among men and women and is most commonly seen in those between the ages of 15 and 60.
Bell’s palsy is the result of trauma, damage, or inflammation of one of the facial nerves. This can occur because of facial or head trauma or inflammation, swelling, or compression of the nerve. Researchers aren’t sure what causes the nerve to become damaged in those instances when physical trauma is ruled out. Most think a virus is to blame, such as the herpes simplex (cold sore) virus or viral meningitis; however, the condition has also been linked to Lyme disease, tumors, high blood pressure, sarcoidosis, headaches, the flu, and chronic middle ear infections. Interestingly, a disproportionately high number of cases occur in individuals with an upper respiratory infection or diabetes.
Symptoms can range from mild weakness or total paralysis. It typically affects only one side of the face but can, rarely, affect both. The most common symptoms are twitching weakness and paralysis but drooping of the eyelid and/or corner of the mouth, drooling, excessive tearing of one eye, impairment of taste, dryness of the eye or mouth, headache, loss of taste, impaired speech, dizziness, difficulty eating or drinking, pain or discomfort around the jaw and behind the ear, hypersensitivity to sound on the affected side, and ringing in one or both ears.
If the underlying cause is known, correcting it, such as with antibiotics for Lyme, tumor removal, etc., may reverse symptoms. If the cause is unknown, treatment usually starts with prednisone, a corticosteroid that reduces inflammation. Other options may include antiviral medication and pain relievers. Eye protection, relaxation techniques, acupuncture, electrical stimulation, biofeedback, physical therapy, and vitamin therapy may also be beneficial. Surgical decompression of the nerve is controversial and may not provide significant relief and is therefore rarely recommended. In some cases, cosmetic or reconstructive surgery may be needed to repair permanent damage, such as a drooping eyelid that doesn’t close completely, causing the eye to dry.
For most, with or without treatment, symptoms begin to improve in about two weeks with normal function returning in three to six months. Some individuals may experience symptoms for a longer period of time and a few individuals may development permanent damage. Rarely, Bell’s palsy can recur.
Because you have had symptoms for so long, the damage is likely permanent. Stress is not a cause, and while you may never know what the original cause was, you should talk with your current physician or an ENT specialist. If there is lingering nerve swelling or inflammation, another round of treatment may be beneficial. Keep in mind that high blood pressure may have played a role, and if you don’t have adequate control with diet, exercise and medication, it may be a contributing factor.
You can learn more about this from the National Institute of Neurological Disorders and Stroke’s website, www.ninds.nih.gov/disorders/bells/details_bells.htm or from the Bell’s Palsy Information Site, www.bellspalsy.ws.
Because high blood pressure can be a cause of Bell’s palsy, readers who are interested in learning more can order my Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.