Bell's palsy is characterized by sudden, unilateral facial paralysis that develops over 48 hours. Early symptoms include weakness of facial muscles, poor eyelid closure, ear pain, taste alterations, and numbness of the cheek or mouth. Diagnosis is based on the clinical history and physical exam findings of unilateral facial paralysis without signs of central nervous system, ear, or brainstem involvement. Treatment involves a 5-day course of high-dose corticosteroids if started within 72 hours, along with eye protection and antiviral medication to prevent secondary infection.

1. Bell’s Palsy
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3. Early symptoms:
• Weakness of the facial muscles
• Poor eyelid closure
• Aching of the ear or mastoid (60%)
• Alteration of taste (57%)
• Hyperacusis (30%)
• Tingling or numbness of the cheek/mouth
• Epiphora
• Ocular pain
• Blurred vision
• Onset: typically sudden
• Symptoms: peak in less than 48 hours

4. DX
• based on history and PE & diagnostic testing
• Bell’s palsy is a diagnosis of exclusion.
• Clinical fx that distinguish it from other causes
of facial paralysis:
1) sudden onset of unilateral facial paralysis
2) absence of signs and symptoms of
CNS, ear, and cerebellopontine angle disease.

5. Symptoms:
• Acute onset of unilateral upper and lower
facial paralysis (over a 48-h period)
• Posterior auricular pain
• Decreased tearing
• Hyperacusis
• Taste disturbances
• Otalgia

6. Investigations:
• MRI: may show SOL, stroke or MS
• CSF: to check for infection
• Serology:
1) Lyme Disease high Borrelia antibodies
2) High VZV antibodies in Ramsay Hunt Syndrome
• Nerve Conduction Studies: at 2wks predict
delayed recovery by showing axonal
degeneration

7. prognosis
• Incomplete paralysis without axonal
degeneration: covers completely within a few
weeks
• Complete paralysis:
80% full spontaneous recovery
15% with axonal degeneration: recovery is
delayed, starting after 3 months

8. management
• Prednisolone 60mg/day for 5days (tailing by
10mg/day – if given within 72hours of onset-
improved recovery time
- 95% making a full recovery
- Prednisolone acts by reducig axonal edema
and damage

9. management
• Protect the eye: give Artificial tears
- Dark glasses
- Encourage regular eyelid closure
• Aciclovir 800mg 5x/day for 5-7days