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Sharing Care - Bell's Palsy

Bell's palsy presents with weakness of one side of the face, occasionally preceded by tingling or numbness in the face.  It is usually unilateral and evolves over hours to a few days.  It is believed to be caused by a viral inflammation in or around the facial nerve.  80% of patients make a good recovery within one year.

1. Diagnosis

The typical features in the history are of a sub-acute onset without other symptoms of CNS dysfunction.  Occasionally hearing can be hyperacute and the patient perceives a sensation of numbness over the face.  On examination the signs are of a lower motor neuron facial palsy.  In Ramsay-Hunt syndrome the facial palsy is associated with blisters in the ear along with pain and hearing impairment.

2.Investigation

Examination of the ear is mandatory.  Blood tests may be helpful, depending on context.

3. Management

If the condition is seen early, advised current therapy is the combination of high dose steroid (eg prednisolone 60mg for five days) and an oral antiviral therapy eg acyclovir.

4. Physiotherapy

The physiotherapy department at GRH offer assessment and management of recent onset Bell's palsy.  

The department has produced downloadable leaflets offering advice and exercise after Bell's palsy.

5.Information

The UK Bell's Palsy association also offers information and advice on the condition.

6. Who to refer to neurology?

Referral to neurology is only necessary where there is diagnostic doubt.  Treatment is best instituted immediately in General Practice.