Bell Palsy Questions & Answers

Updated: Jun 14, 2019
  • Author: Danette C Taylor, DO, MS, FACN; Chief Editor: Selim R Benbadis, MD  more...
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Questions & Answers

Overview

What is Bell palsy (idiopathic facial paralysis) (IFP)?

What are the signs and symptoms of Bell palsy (idiopathic facial paralysis) (IFP)?

Which exams are performed in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the House-Brackmann grading system for Bell palsy (idiopathic facial paralysis) (IFP)?

Which lab tests may be used in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the goals of treatment for Bell palsy (idiopathic facial paralysis) (IFP)?

What is included in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the surgical treatment options for Bell palsy (idiopathic facial paralysis) (IFP)?

What is Bell palsy (idiopathic facial paralysis) (IFP)?

What causes Bell palsy (idiopathic facial paralysis) (IFP)?

What is the prevalence of Bell palsy (idiopathic facial paralysis) (IFP)?

What is a key step in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the minimum diagnostic criteria for Bell palsy (idiopathic facial paralysis) (IFP)?

When is gadolinium-enhanced MRI indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What should be the basis for treatment selection in Bell palsy (idiopathic facial paralysis) (IFP)?

Which treatment is indicated in most cases of Bell palsy (idiopathic facial paralysis) (IFP)?

What information should patients be given for prevention of corneal abrasions in Bell palsy (idiopathic facial paralysis) (IFP)?

What are the roles of the fifth and seventh cranial nerves?

What is the anatomy of the facial nerve?

What is the role of the nervus intermedius in Bell palsy (idiopathic facial paralysis) (IFP)?

Which muscles are innervated by the facial nerve in Bell palsy (idiopathic facial paralysis) (IFP)?

What is the pathophysiology of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the pathophysiology of injury to the facial nerve in Bell palsy (idiopathic facial paralysis) (IFP)?

Is herpes simplex virus (HSV) an etiological factor in Bell palsy (idiopathic facial paralysis) (IFP)?

Can inactivated influenza vaccines cause Bell palsy (idiopathic facial paralysis) (IFP)?

What are possible infectious etiologies for Bell palsy (idiopathic facial paralysis) (IFP)?

Is there a genetic etiology of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the incidence of Bell palsy (idiopathic facial paralysis) (IFP) in the US?

What is the prevalence of bilateral simultaneous Bell palsy (idiopathic facial paralysis) (IFP)?

Which groups are at higher risk for Bell palsy (idiopathic facial paralysis) (IFP)?

Is there a gender predilection for Bell palsy (idiopathic facial paralysis) (IFP)?

Doe the incidence of Bell palsy (idiopathic facial paralysis) (IFP) vary among age groups?

What is the prognosis of Bell palsy (idiopathic facial paralysis) (IFP)?

How likely is complete recovery from Bell palsy (idiopathic facial paralysis) (IFP)?

Which factors increase the likelihood of a full recovery from Bell palsy (idiopathic facial paralysis) (IFP)?

Which factors are associated with a poor outcome in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Does the prognosis for complete recovery from Bell palsy (idiopathic facial paralysis) (IFP) vary among age groups?

How does the risk sequelae will develop in patients with Bell palsy (idiopathic facial paralysis) (IFP) increase over time?

How likely is recurrence of Bell palsy (idiopathic facial paralysis) (IFP)?

Which imaging studies are performed in patients with recurrent Bell palsy (idiopathic facial paralysis) (IFP)?

What is the long-term sequelae of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the manifestation of incomplete motor regeneration in Bell palsy (idiopathic facial paralysis) (IFP)?

What is the pathophysiology of incomplete sensory regeneration in Bell palsy (idiopathic facial paralysis) (IFP)?

What is synkinesis in Bell palsy (idiopathic facial paralysis) (IFP)?

Presentation

How is the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP) made?

What are the signs and symptoms of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the early signs and symptoms of Bell palsy (idiopathic facial paralysis) (IFP)?

Is the onset of Bell palsy (idiopathic facial paralysis) (IFP) sudden or gradual?

How is the facial paralysis of Bell palsy (idiopathic facial paralysis) (IFP) characterized?

How is the facial paralysis in Bell palsy (idiopathic facial paralysis) (IFP) differentiated from other disorders?

What does numbness on the side of the paralysis indicate in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What are the early ocular complications of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the late ocular complications of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the cause of tear flow in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Is posterior auricular pain a symptom of Bell palsy (idiopathic facial paralysis) (IFP)?

How common is hyperacusis in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Is early recovery of taste a positive prognostic factor in Bell palsy (idiopathic facial paralysis) (IFP)?

What are the possible causes of facial spasm in Bell palsy (idiopathic facial paralysis) (IFP)?

Which patients are at increased risk for facial spasms with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the presentation of synkinesis in Bell palsy (idiopathic facial paralysis) (IFP)?

Which symptoms of cranial neuropathy may occur in Bell palsy (idiopathic facial paralysis) (IFP)?

Which exams are performed when Bell palsy (idiopathic facial paralysis) (IFP) is suspected?

Which physical findings are consistent with a diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When should an otologic cause be considered for Bell palsy (idiopathic facial paralysis) (IFP)?

How should the external auditory canal be examined for Bell palsy (idiopathic facial paralysis) (IFP)?

How is hyperacusis tested in Bell palsy (idiopathic facial paralysis) (IFP)?

Which ocular exam findings are consistent with a diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which oral exam findings are consistent with a diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of a neurologic exam in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the House-Brackmann grading system for Bell palsy (idiopathic facial paralysis) (IFP)

What are the characteristics of grade II Bell palsy (idiopathic facial paralysis) (IFP)?

What are the characteristics of grade III Bell palsy (idiopathic facial paralysis) (IFP)?

What are the characteristics of grade IV Bell palsy (idiopathic facial paralysis) (IFP)?

What are the characteristics of grade V Bell palsy (idiopathic facial paralysis) (IFP)?

What are the characteristics of grade VI Bell palsy (idiopathic facial paralysis) (IFP)?

What prognosis is given to each grade of Bell palsy (idiopathic facial paralysis) (IFP)?

DDX

What should be considered in the differential diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

How is seventh nerve neoplasm differentiated from Bell palsy (idiopathic facial paralysis) (IFP)?

How are tumors of the facial nerve or parotid gland differentiated from Bell palsy (idiopathic facial paralysis) (IFP)?

When should Lyme disease be considered in the differential diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When should Ramsay Hunt syndrome be considered in the differential diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which disorders should be considered in the differential diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which disorders should be considered in differential diagnosis of Bell palsy (idiopathic facial paralysis) (IFP) based on history?

Which disorders should be considered in the differential diagnosis of bilateral simultaneous Bell palsy (idiopathic facial paralysis) (IFP)?

What are the differential diagnoses for Bell Palsy?

Workup

When is testing indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which tests are performed to identify or exclude other disorders in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of serum titers for herpes simplex virus (HSV) in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which test is performed to exclude Wegener granulomatosis in Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of serum titers (IgM and IgA) for M pneumoniae in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of salivary flow testing in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

How is the Schirmer blotting test used in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of a nerve excitability test in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the AAO-HNSF recommendations for diagnostic imaging and routine lab testing for Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of conduction testing and electromyography (EMG) in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Which nerve conductions findings have prognostic significance in Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of electroneurography in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of electrodiagnostic testing in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When is electrodiagnostic testing not recommended in Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of brainstem auditory evoked response (BAER) in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When is brainstem auditory evoked response (BAER) indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When are audiography and auditory evoked potentials (AEPs) indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of blepharokymographic analysis in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the histologic findings of Bell palsy (idiopathic facial paralysis) (IFP)?

When are imaging studies indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of MRI in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

When is gadolinium-enhanced MRI indicated in the diagnosis of Bell palsy (idiopathic facial paralysis) (IFP)?

Treatment

What are the goals of treatment for Bell palsy (idiopathic facial paralysis) (IFP)?

When is treatment considered for patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of the emergency department (ED) in treating patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What are the AAN recommendations for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Which nonpharmacologic therapies may be beneficial in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the surgical options for treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the efficacy of surgical treatments for Bell palsy (idiopathic facial paralysis) (IFP)?

What is the most widely accepted treatment for Bell palsy (idiopathic facial paralysis) (IFP)?

Do the AAN and the AAO-HNSF both recommend corticosteroids for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the efficacy of prednisone and prednisolone for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Is acyclovir (Zovirax) effective in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Is valacyclovir (Valtrex) effective for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the recommended dose of prednisone for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Are high-dose steroids safe for the treatment of Bell palsy (idiopathic facial paralysis) (IFP) in patients with diabetes?

What is the role of antiviral agents in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the AAN recommendation for the use of acyclovir (Zovirax) in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Does acyclovir (Zovirax) reduce the rate of incomplete recovery from Bell palsy (idiopathic facial paralysis) (IFP)?

What is the dosage of acyclovir (Zovirax) for treating Bell palsy (idiopathic facial paralysis) (IFP)?

What is the dosage of valacyclovir (Valtrex) for treating Bell palsy (idiopathic facial paralysis) (IFP)?

What is the efficacy of combination therapy with prednisone and an antiviral agent for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Are corticosteroids plus antiviral agents more effective than corticosteroid therapy alone for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Should antiviral agents be used as monotherapy for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the options for eye care for patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Which treatment is required for corneal erosions in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of external eyelid weights in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Which measures help lower-lid ectropion or droop in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of botulinum toxin (BTX) in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Which patients with Bell palsy (idiopathic facial paralysis) (IFP) may receive the most benefit from surgical intervention?

When is surgery indicated in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of middle fossa decompression in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is a suborbicularis oculi fat (SOOF) lift for the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

How is a suborbicularis oculi fat lift (SOOF) performed in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

When are eyelid implants indicated in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What are the possible complications of eyelid implants in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of tarsorrhaphy in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

What is the role of transposition of the temporalis in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

When is facial nerve grafting or hypoglossal-facial nerve anastomosis indicated in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

When is direct brow lift indicated in the treatment of Bell palsy (idiopathic facial paralysis) (IFP)?

Which tests should be performed if paralysis is not resolving or is progressing to complete paralysis in Bell palsy (idiopathic facial paralysis) (IFP)?

When is a consultation with a neurologist or otolaryngologist indicated in patients with suspected Bell palsy (idiopathic facial paralysis) (IFP)?

When is an evaluation by an otolaryngologist or an ophthalmologist indicated for patients with Bell palsy (idiopathic facial paralysis) (IFP)?

When is monitoring indicated for patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Medications

What are the goals of pharmacotherapy in patients with Bell palsy (idiopathic facial paralysis) (IFP)?

Which medications in the drug class Corticosteroids are used in the treatment of Bell Palsy?

Which medications in the drug class Antivirals are used in the treatment of Bell Palsy?