The Bell’s Palsy Condition
He got irritated when he noticed that water is easily getting into his eyes when he was washing his face. He washed his mouth but water keeps spilling. He then consciously felt the numbness on the right side of his face. This is a recount of what a friend felt over his personal discovery of the Bell’s Palsy. In the past month, two people close to me were diagnosed with Bell’s Palsy. I also knew very recently that an aunt and a cousin have also experienced this way back in the 80’s and have recovered. It is a condition that causes facial muscles to weaken and enter into a paralysis. With the frequency of this event, at least for me, I started to research on how Bell’s Palsy starts and how it can be overcome.
The term Bell’s Palsy is named after a Scottish surgeon, Sir Charles Bell, who studied the cranial nerve and it innervations some 200 years ago. Bell’s Palsy or facial paralysis is caused by trauma to the “facial nerve” or the 7th cranial nerve, which is responsible for the movement and the feelings in our facial muscles. The cranial nerve spans from the brain to the left and right sides of the face, and paralysis can be on one side or both. This condition does not lean to any race, gender or age, although most studies show that the condition is manifested to those who are 16-60. Some Hollywood stars also have had this condition such as George Clooney, Pierce Brosnan and Sylvester Stallone.
What Causes Bell’s Palsy?
The common causes of Bell’s Paly, through still undetermined in detail, are bacterial and viral infections, and autoimmune disorders. In the 1990’s, Bell’s palsy are considered as “idiopathic” or source and reason unknown, but through new theories and the researches, the common causes have been determined:
Source: medicalcenter.osu.edu via Philippine Star
- Herpes Simplex Virus 1 (HSV1)
60%-70% of Bell’s Palsy cases pointed to the exposure to Herpes Simplex Virus 1 (HSV-1). According to Bell’s Palsy information website, HSV-1 is a common virus where everyone is exposed to, even children. The most often sources of exposure are kissing between relatives, sharing utensils, and sharing towels. The virus is said to be infectious at a certain time, but later becomes dormant and later resides on the nerve tissue. Our immune system has its way of producing antibodies to fight these types of viruses by causing inflammation.
However, when the dormant virus becomes activated in a certain canal where there is very little room for inflammation, the nerve may be inflamed, or pressed against by the inflammation. This compression and inflammation stops the transmission of signals to the muscles, and later cause temporary weakness of paralysis in the face.
- Ramsey Hunt Syndrome
The virus varicella zoster (VZV) is responsible for the occurrence of Ramsey-Hunt syndrome and chicken pox. This virus remains in the body and resides on the nerve tissue in a dormant state for several years and may increase incidence in ages 50 and above. The Ramsey Hunt syndrome displays the same symptoms as Bell’s Palsy and must be immediately checked for treatment.
According to studies, HIV can increase the chances of Bell’s Palsy. During the early stage of HIV, the paralysis can be directly cause by the viral infections. Other opportunistic infections or tumors associated with severe immune deficiency can cause latter stages of paralysis.
- Lyme Disease
With Lyme Disease, bacteria enters the body through the skin at the site of a tick bite. It is shown with a red ring around the bite site and shows flu-like symptoms. Without immediate antibiotic treatment, the bacteria can spread throughout the body and can cause nervous system disorders, such as facial paralysis.
- Otitis Media
Acute and chronic middle ear infections can invade the canal around the nerve through small portals from the ear. Similar to the viruses, bacteria can cause inflammation and will have the tendency to compress the nerve that will cause for it to weaken to paralyze.
- Other Causes
Facial palsy can also be caused by other triggers such as trauma due to force, bone fracture, brain injuries, cysts and tumors and surgical wounds. It is also said that 40% of diabetic patients are prone to having facial palsy. Some thyroid conditions may also cause Bell’s Palsy.
What Triggers Bell’s Palsy?
Based on my friend’s condition, the Bell’s Palsy was caused by hypertension, which were triggered by a number of factors. He remembers that before he felt the symptoms, he felt very cold over his face during his sleep. Some friends even tell him that the airconditioning or the electric fan must have been always focused on the face. Which reminds me of how our elders warn us kids back in the province – Back in the days, as rowdy and playful kids, we make funny faces. Our elders always say that the wind might pass through our faces to freeze it. “Baka mahipan ka nang hangin” [“Wind might gust on you”].
But based on medical accounts, nobody knows the exact triggers of Bell’s Palsy. But the most common causes include impaired immunity, stress, lack of sleep, minor illnesses, trauma and upper respiratory infections. In Eastern medicine however, they say that it is the occurrence of the yin and the yang. “The face should be yang or hot, and when the yin or cold gets trapped in the yang of the face, it causes paralysis.”
In the Philippines, where the two of my friends are located, most cases of Bell’s Palsy are manifesting in cold and air-conditioned areas, and the patients are mostly experiencing fatigue.
Once the virus or bacteria is triggered, the symptoms can immediately manifest in 48 hours. Some people however experience the progression very quickly. In some stories, they experience the paralysis in moments, like while brushing their teeth, or immediately after waking up.
Signs and Symptoms
In my friends’ case, the facial numbness and paralysis, and worsening speech were first diagnosed to be a stroke, as his blood pressure was 150/120. To rule this out, he was confined at the hospital to check his body reflexes. The initial symptoms started on a Tuesday and by Thursday, he was confined for five days for further observation.
In the Bell’s Palsy information site, the symptoms can peak within a few days or as long as two weeks. Paralysis in the face will develop slowly. And I personally think that apart from the physical effects, this condition can also affect a person’s self-esteem.
Facial paralysis has many physical symptoms but varies on the degree of nerve damage:
- General Effects
- Muscle weakness or paralysis
- Forehead wrinkles disappear
- Overall droopy appearance
- Impossible or difficult to blink
- Nose runs
- Nose is constantly stuffed
- Difficulty speaking
- Difficulty eating and drinking
- Sensitivity to sound (hyperacusis)
- Excess or reduced salivation
- Facial swelling
- Diminished or distorted taste
- Pain in or near the ear
- Eye-related Effects
- Eye closure difficult or impossible
- Lack of tears
- Excessive tearing
- Brow droop
- Tears fail to coat cornea
- Lower eyelid droop
- Sensitivity to light
- Residual Effect
- Eye appears smaller
- Blink remains incomplete or infrequent
- Tearing abnormalities
- Asymmetrical smile
- Mouth pulls up and outward
- Sinus problems
- Nose runs during physical exertion
- Post paralytic hemifacial spasm
- Hypertonic muscles
- Co-contracting muscles
- Synkinesis (oral/ocular well known, but can affect any muscle group)
- Sweating while eating or during physical exertion
- Muscles become more flaccid when tired, or during minor illness
- Muscles stiffen when exposed to cold, when tired, or during illness
The treatment for Bell’s Palsy can include the use of pain killers, steroids for inflammation, and antivirals. My friend’s treatment first included the stabilization of his blood pressure before steroids was administered to him. Some patients also use non-traditional methods such as therapies and acupuncture. Eating foods that are rich in copper such as nuts, potatoes, vegetables, and whole grains can also help in the recovery.
It was also said that it is good to exercise the face every now and then to enliven the muscles. I also knew from some relatives that my aunt and my cousin who have both experienced Bell’s Palsy when there when no exact cure or therapy to it yet have resorted to the use of bubblegum. The constant chewing, according to the elders, can help exercise the muscles until it regains its full strength.
Recovery and Residual Effects
My friend has responded well to the steroids and is now recovering well after a month of diagnosis. He has endured difficulty in speaking and of course eating. Communication was a challenge because people do not understand what he was trying to say. Food intake also becomes a task as chewing food becomes difficult, that it came to the point that he took his food with a straw.
The recovery from Bell’s Palsy, according to studies, can be complete and spontaneous. A common time frame for the healing is three months, with the right therapy and treatment. About 50% of Bell’s Palsy patients are able to recover completely at shorter time spans and 35% recovers within a year.
The recovery period will require the non-inflammation of nerves and the regeneration of the nerves which is estimated at 1-2 millimeters per day at a continued regeneration rate of 18 months. Beyond this time frame, there can be observed general appearance in the face.
I truly feel for my friends who have recovered and continually recovering from Bell’s Palsy. Though difficult, this condition should not stop anyone from pursuing their goals in life. More than just support from friends and family, patients with Bell’s Palsy also need the help of people around them. My friend tells me that the best part of having Bell’s Palsy is knowing that it is not a stroke that involved the entire body, and that it is treatable. Enduring the condition while healing, is of course a story of patience, persistence to overcome and endurance.
The difficulty of dealing with a paralyzed face and half-smile can be devastating for some patients, let us not make it worse for them by throwing a sneering look or by laughing or by mocking them. Instead, let us help them maintain a positive thought in overcoming it and help educate people around us of its causes, symptoms and cure.