How long do bell palsy last

Table 1 1 , 6 — 8 summarizes the differential diagnosis of Bell's palsy. Patients with A a facial nerve lesion and B a supranuclear lesion with forehead sparing. History of tick exposure, rash, or arthralgias; exposure to areas where Lyme disease is endemic. Information from references 1 and 6 through 8. Influenza vaccines in the past have been associated with peripheral neuropathies. Although influenza vaccines currently available in the United States have not been associated with Bell's palsy, 9 — 11 a recently developed Swiss intranasal vaccine was found to have a very high risk of postvaccine facial nerve palsy and has been withdrawn from use.

A patient with an acute onset of unilateral facial weakness most likely has Bell's palsy. A careful history of the onset and progress of paralysis is important because gradual onset of more than two weeks' duration is strongly suggestive of a mass lesion. Medical history should include recent rashes, arthralgias, or fevers; history of peripheral nerve palsy; exposure to influenza vaccine or new medications; and exposure to ticks or areas where Lyme disease is endemic. The physical examination should include careful inspection of the ear canal, tympanic membrane, and oropharynx, as well as evaluation of peripheral nerve function in the extremities and palpation of the parotid gland.

In order to assess forehead involvement, physical examination should also include evaluation of cranial nerve function, including all facial muscles. Laboratory testing is not usually indicated. However, because diabetes mellitus is present in more than 10 percent of patients with Bell's palsy, fasting glucose or A1C testing may be performed in patients with additional risk factors e.

Signs and symptoms atypical for Bell's palsy should prompt further evaluation. Patients with insidious onset or forehead sparing should undergo imaging of the head. Those with bilateral palsies or those who do not improve within the first two or three weeks after onset of symptoms should be referred to a neurologist. Oral corticosteroids have traditionally been prescribed to reduce facial nerve inflammation in patients with Bell's palsy. Prednisone is typically prescribed in a day tapering course starting at 60 mg per day.

Because of the possible role of HSV-1 in the etiology of Bell's palsy, the antiviral drugs acy-clovir Zovirax and valacyclovir Valtrex have been studied to determine if they have any benefit in treatment. Either acyclovir mg can be given five times per day for seven days or valacyclovir 1 g can be given three times per day for seven days.

Although a Cochrane review found insufficient evidence to support the use of these antivirals alone, 15 two recent placebo-controlled trials demonstrated full recovery in a higher percentage of patients treated with an antiviral drug in combination with prednisolone than with prednisolone alone percent versus 91 percent and 95 percent versus 90 percent.

It is difficult to establish a statistically significant benefit of treatment in placebo-controlled trials because Bell's palsy has a high rate of spontaneous recovery. The Copenhagen Facial Nerve Study evaluated 2, persons with untreated facial nerve palsy, including 1, with idiopathic Bell's palsy and with palsy from other causes; 70 percent had complete paralysis.

Function returned within three weeks in 85 percent of patients, with 71 percent of these patients recovering full function. Of the 29 percent of patients with sequelae, 12 percent rated it slight, 13 percent rated it mild, and 4 percent rated it severe.

Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy. Patients who present with complete facial nerve paralysis have a lower rate of spontaneous recovery and may be more likely to benefit from treatment.

In the past, surgical decompression within three weeks of onset has been recommended for patients who have persistent loss of function greater than 90 percent loss on electroneurography at two weeks. However, the most widely cited study supporting this approach only reported results for a total of 34 treated patients at three different sites, included a nonrandomized control group, and lacked a blinded evaluation of outcome.

The most common complication of surgery is postoperative hearing loss, which affects 3 to 15 percent of patients. Based on the significant potential for harms and the paucity of data supporting benefit, the American Academy of Neurology does not currently recommend surgical decompression for Bell's palsy.

Some published studies have reported benefit with acupuncture versus steroids and placebo, but all had serious flaws in study design and reporting. Creatinine clearance : Less than 10 mL per minute 0.

Gastrointestinal upset, headache, dizziness, elevated liver enzymes, aplastic anemia rare. Children older than two years: 80 mg per kg daily divided every six hours for five days, with a maximal dose of 3, mg daily.

Creatinine clearance : Less than 10 mL per minute: mg daily. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee. Patients with Bell's palsy may be unable to close the eye on the affected side, which can lead to irritation and corneal ulceration.

The eye should be lubricated with artificial tears until the facial paralysis resolves. Permanent eyelid weakness may require tarsorrhaphy or implantation of gold weights in the upper lid. Facial asymmetry and muscular contractures may require cosmetic surgical procedures or botulinum toxin Botox injections. In these cases, consultation with an ophthalmologist or cosmetic surgeon is needed. Already a member or subscriber?

Log in. Interested in AAFP membership? It can affect anyone of any gender and age, but its incidence seems to be highest in those in the to year-old age group. A diagnosis of Bell's palsy is made based on clinical presentation—acute facial nerve weakness or paralysis on one side of the face with onset in less than 72 hours—and by ruling out other possible causes of facial paralysis. There is no specific laboratory test to confirm diagnosis of the disorder. Generally, a physician will examine the individual for upper and lower facial weakness.

Routine laboratory or imaging studies are not necessary for most cases, but sometimes they can help to confirm the diagnosis or rule out other diseases that can cause facial weakness.

A test called electromyography EMG, which uses very thin wire electrodes that are inserted into a muscle to assess changes in electrical activity that occur during movement and when the muscle is at rest can confirm the presence of nerve damage and determine the severity and the extent of nerve involvement.

Blood tests can sometimes help in diagnosing other concurrent problems such as diabetes and certain infections. Diagnostic imaging using magnetic resonance imaging MRI or a computed tomography CT scan can rule out other structural causes of pressure on the facial nerve such as an artery compressing the nerve and also check the other nerves.

In most instances, oral steroids should be started within 72 hours of symptom onset if possible, to increase the probability of good facial functional recovery. Some individuals with co-existing conditions may not respond well to or be able to take steroid drugs.

Antiviral agents in addition to steroids might increase the probability of recovery of facial function, although their benefit has not been clearly established. Analgesics such as aspirin, acetaminophen, or ibuprofen may relieve pain. Because of possible drug interactions, individuals taking prescription medicines should always talk to their doctors before taking any over-the-counter drugs.

Another important factor in treatment is eye protection. Bell's palsy can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Keeping the eye moist and protecting it from debris and injury, especially at night, is important. One of your eyelids may sag, or you may have trouble closing that eye.

You may also notice a loss of the sense of taste, dizziness, ringing in your ear tinnitus or other symptoms that point to a problem with the facial nerve. Within three months, most people have recovered full motion and function of their face. A delay in recovery is often accompanied by some form of abnormal facial function. Kofi Boahene, M. Cognitive functioning and other physical abilities are not impaired.

Other main symptoms include:. The facial nerve is the seventh cranial nerve. Each nerve runs from the brain just under the ear and splits into several branches. The facial nerve has a number of functions, with both sensory and motor components.

It supplies the muscles of facial expression and the muscles used to close the eyes. It innervates the lacrimal, submandibular, and sublingual glands, as well as the mucous membranes of the nasopharynx, and the hard and soft palates. It is responsible for taste from part of the tongue and the hard and soft palates.

The facial nerve is also responsible for general sensation from the skin of the ear. Statistics show little discrepancy between incidence in males and females and in different races. Research suggests that those aged between 15 and 45 years, however, have an increased risk of developing the condition, as do pregnant women. It has not yet been established why the inner ear becomes inflamed but links have been made with viral infections including herpes simplex and varicella zoster , as well as a weak immune system and stress.

A doctor will examine the patient and ask him or her to perform a range of facial movements, such as closing the eyes, puckering the lips, raising the eyebrows and smiling. To eliminate other possible causes of facial palsy, the doctor may also request that the patient is tested for Lyme disease, diabetes, sarcoidosis and HIV.