brain, spinal cord, and nerve disorders
Bell Palsy
Symptoms of Bell Palsy
In Bell palsy, pain behind the ear may be the first symptom. Facial muscles weaken suddenly, usually within hours. The effect ranges from mild weakness to complete paralysis. By 48 to 72 hours, the weakness is as severe as it will be. Only one side of the face is affected. In facial nerve palsies, the face becomes flat and expressionless. However, when only one side is affected, people often feel as though the face is twisted because the muscles on the unaffected side tend to pull the face to that side every time they make a facial expression. Wrinkling the forehead, blinking, and grimacing may be difficult or impossible on the affected side. For most people, the face feels numb or heavy, even though sensation remains normal. Closing the eye on the affected side may be difficult. People may be unable to close the eye completely, and they blink less frequently. The eye also tends to turn upward when it is closed. The production of saliva and tears may be impaired. People may have dry eyes and mouth, or they may drool. Because fewer tears are produced and the eye blinks less often (blinking helps moisten the eye’s surface), the eye becomes dry, resulting in pain and eye damage. Eye damage is usually minor but can be serious if the eye is not moistened and protected another way. People may be unable to taste with the front part of the tongue on the affected side. The ear on the affected side may perceive sounds as abnormally loud (a condition called hyperacusis) because the muscle that stretches the eardrum is paralyzed. This muscle is located in the middle ear. Evidence suggests that the viruses that cause cold sores or shingles are common causes of Bell palsy. Lyme disease can cause a facial nerve palsy. Occasionally, as the facial nerve heals, it forms abnormal connections, resulting in unexpected movements of some facial muscles or in watering of the eyes (“crocodile tears”) during salivation. Because the facial muscles are not used for a long time, permanent tightening of the muscles (contractures) occasionally occurs. 