Surviving Bell's Palsy

An encouraging comment of a father whose child suffers the sickness

2010-06-20T17:20:00.000-07:00

Just this week, i received several comments from readers. this one is very encouraging, from Yongcon

Thanks for sharing these information regarding Bell's Palsy and your experience.

My 8 year-old son was struck by this facial paralysis about a week ago. It was caused by the infection in the Parotid gland(salivary gland).

After hospitalized for two days with steroids and anti-botics, the infection has weakened but the paralysis is still there.

It is so hard to see my little son suffering this. And I have tried and read every available resources on the web and came across your blog.

It is not the informative part, but the part that you wrote about your experience which did help me.

The feeling that my family is not alone does releave my concern and anxiety.

So now I do understand we have to be VERY PATIENT during this healing process. And the very best help for my son from me right now is being patient, calm and supportive of him.

Again, thank you so much and I hope the best for your life!

Best regards,

Yonggon from Ellicott City, MD

Thanks so much, Yonggon. I sincerely prayed for the speedy recovery of your child.

Josh's Story: How to minimize the residue

2008-03-13T18:35:00.000-07:00

hello josh,

im sorry i just read your comment this morning. first of all thank you for reading my blog and asking for advice.

honestly, based on my bulky readings during the time i had bell's palsy, several indeed have what they call "residue" after the illness. i am lucky that mine is not very evident. when i feel stressed, i just feel small veins in my eyes twitching.

well, gosh, i believe in our own efforts we could make ourselves better. anyways, research are done on the patients, right? its all about us, and its up to us to make breakthroughs.

i suggest gosh that you avoid being stressed out. it gives our facial nerves trauma, which causes the paralysis. a happy mood and occasional laugh helps. also, try to coninue the facila muscle exercises, although do not tire your self. do it as a sort of playful act infront of the mirror. i also suggest that you continue to drink the neuro-b's vitamins. the vitamins are good for the veins for prope blood flow. they are cheap and i it is over the counter medicine.

i hope you will tell me if these works. thanks josh and im glad to hear stories from the people who really exeprienced it.

Josh's comment:
Hello. I had bell's palsy about 15 years ago. Since my recovery I have had a problem with my face. When my eye blinks, the corner of my mouth goes up. It has been this way for many years, but I am just realizing that there is possibly something I can do about it. Is there? Do you know who I would contact to try and fix this problem that makes me very self-conscious. It would be a miracle if I could fix it!Thank You

A comment from a reader with Bell's Palsy

2007-11-14T16:37:00.001-08:00

I just received two comments from a reader. She had bell's palsy when she was 12, and now she have it again. Here are her messages:

Carmel said...: I had Bell's Palsy when I was 12 or 13 years old. I have it again, I am 4 months and 2 weeks pregnant and 35yo. I have had it for 4 days now, I can still move my face but it's a little restricted, my eye wont close properly, it's difficult to drink etc. I am hoping that it doesn't get worse. I guess it would have by now.; I almost forgot to mention. I did not get my movement back 100% from when I was 12 or 13 yo. I hope that I get it all back this time. Time will tell I guess.
Dear Carmel,

First of all thank you for sharing with me your experience. I am sorry that you have it again. Actually, research shows that pregnant women are more prone to the sickness, or more likely to have it again during pregnancy. I understand that having the sickness at pregnancy is more terrible than having it on ordinary days because it adds the insecurities we have while in the "bulky" state of pregnancy. I had mine when I was pregnant with my second daughter.

Its so sad in your case that you have the residual effect. Based on what I've research on the net, majority indeed experience residual effects. I guess i have few, too, but not very evident. Just sometimes when I am tired or fatigued the corner of my eyes twitches. It really scares me because sometimes it really shows even on my normal days.

Are you having medication? My neuro surgeon told me that neuro vitamins really helps to help the veins repair themselves and to avoid further residual effects. It is an over-the-counter vitamins and is cheap. Also, you need to massage your face often to help he veins recover immediately. Physical therapists are perfect for the job, but my doctor said i can do it at home. And it works for me. See my earlier post on how to do it.

I am glad I met someone who understands this situation. Do you know that we are 10 of every hundred thousands?

I hope to hear news from you again. Be strong, girl.

Residual Effects of Bell's Palsy

2007-10-01T18:03:00.000-07:00

by H. Jacqueline Diels, Occupational Therapist

Most people who develop Bells palsy will recover completely and spontaneously (i.e. without any physical therapy) within 3 months. The following discussion is intended to review and clarify the possible residual effects that can be present in cases where recovery from Bell's palsy is delayed beyond the 3 months point. Generally, the longer the recovery takes beyond the initial three months, the more severe the residual effects.

Residual effects can include eye problems (decreased lid closure / increased lid closure, dryness / excessive watering / watering during eating [crocodile tears]), nasal problems (running nose, dryness, collapsed nostril), and others. This discussion will focus primarily on the residual effects as they pertain to facial movement.

For the person who has facial paralysis after Bell's palsy there are typically 2 stages of recovery. In the first stage (first 3 months) there may be no facial movement at all. In this phase, nerve healing is taking place as the inflammation caused by the virus subsides. The affected side of the face may droop. The eye may be unable to close or blink and tearing may be decreased. There can be corneal dryness due to decreased lubrication coupled with exposure to air. There is risk of corneal damage. Patients should be followed by an ophthalmologist during this period to ensure a healthy eye. Weakness of the mouth muscles may cause difficulty with eating, drinking and speaking. The face may pull uncontrollably toward the unaffected side.

As nerve recovery takes place you may notice small facial movements beginning. People recover at different rates, but generally this process will be complete in the three months after onset. If recovery is delayed you may begin to notice movements in areas of the face that you are not even trying to move. For example, when you smile the eye may close or twitch or when you close you eye the corner of your mouth may pull up or out to the side. This condition is known as synkinesis. It is characterized by uncoordinated or unsynchronized facial movements that occur along with normal movements. Synkinesis varies in severity from mild to severe. In its worst form, mass action, it can result in uncontrollable movement of the facial muscles on the affected side during any attempted expression. The affected side of the face may feel tight as the result of the uncontrolled muscle contractions (spasms).

Many people, when describing their history of facial paralysis after Bell's palsy describe it something like this: "I had no movement for about 3 months and then it started to come back. It was getting better and better and then suddenly it started getting worse again". So what happens in this transition between getting better and getting worse again? Specific areas of synkinesis can sometimes be difficult to identify, because in a severe form it can result in what appears to be no active facial movement. So how do you differentiate this condition from the first phase of facial paralysis when you have no movement? It is the difference between lack of muscle function resulting in no movement and too much muscle contraction resulting in completely restricted movement.

Synkinesis is theorized to be the effect of abnormal nerve regeneration, where some of the healing facial nerve fibers can actually implant themselves into the wrong muscles. Think of the facial nerve as a telephone cable. If you cut through a telephone cable you see many different color-coded wires. The telephone repair person can repair the broken cable by reconnecting the wires according to their color. The facial nerve cable is about the diameter of a strand of thin spaghetti. Within that strand are between 6000-7000 different nerve fibers (wires) which conduct the electrical signal from the brain to the facial muscles causing them to contract. They are very delicate and obviously have no color-coding. Inflammation from the Bell's palsy can harm, or "break" some of these very frail fibers. In time the damaged fibers heal. They regenerate at the rate of about 1-2mm per day. But there's no mechanism that directs these fibers back into their original muscles. The brain sends the signal for the muscle to contract thinking the nerve fiber is still connected to the original muscle, but instead, the nerve may be lodged in an entirely different muscle, which then contracts at the same time.

Facial Exercises

2007-09-24T18:34:00.000-07:00

The majority of Bell's palsy cases will resolve without intervention or exercise. Patience is more important during recovery than pushing to exercise muscles that are likely to return to full function without assistance. Some cases will result in incomplete recovery or leave residuals. These exercises are not meant to replace a customized program under the supervision of a professional facial retraining therapist - If you feel you need professional help, don't hesitate to get it.

GENERAL GUIDELINES FOR OLD AND NEW CASES...
Keep a couple of things in mind as you exercise with Bells palsy ... You need to be patient, and work the muscles gently. The idea is not only to regain motion, but for the motion to be balanced with the good side. Don't force things to the point that the two sides pull against each other. If you see a motion pulling other muscles that shouldn't be moving, back off a little, and freeze it at that point, and relax the muscles that shouldn't be moving. Keep your eyes on those eager-beaver muscles in the cheek area as you work your eye or mouth. And check the muscle that runs down your neck to make sure it doesn't "pop out". Keep the muscle movements appropriately isolated. Pay attention to your face as you exercise - focus on watching and feeling what the good side is doing, and then mentally visualize it on the Bell's palsy side and try to recreate it in tiny increments. Use a mirror - the feeling of motion you get while exercising can be very deceptive, so this is important. The mirror will also help you avoid letting the good side overcompensate by moving in an exaggerated way.

Remember not to push it - better to hold a position at the point it can go without inappropriate muscles jumping in to help than to try too hard to do things your face isn't ready for. Movements will elongate with time.

Exercise in short sessions, but repeat the routine 2-3 times a day, more if you can. Quantity is not as important as quality, so don't do your exercises when you're tired.

** It's better to exercise correctly just a few times than to do it incorrectly many times.**

What is the Prognosis?

2007-09-23T20:16:00.001-07:00

The prognosis for individuals with Bell's palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal function within 3 to 6 months. For some, however, the symptoms may last longer. In a few cases, the symptoms may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.

The most effective treatment-- Touch Therapy from family, friends

2007-09-23T20:02:00.000-07:00

Suffering Bell's palsy is not an easy experience especially to individuals with extrovert personalities, and when physical appearance matters most. It is more aggrieved by the doctors' advices that the sickness has no standard cure, in fact, it heals in its own time.

Aside from the tablets the doctors advice, especially the neuro-Bs, doctors also recommend patients to undergo physical therapy sessions. in my case (which i cannot afford the advices daily therapy sessions, my doctor advised me to massage the affected areas with a towel soaked in lukewarm water. I was also told to do facial muscle exercises (make face in front of the mirror) to aid the facial veins into healing. My husband diligently and lovingly massage my face every night without remorse even with my wailings and bitterness. Note to the family and friends of someone with this illness: please give more than enough patience and understanding since the sickness is very much frustrating.

I suffered this illness for four weeks. the recovery was considered speedy as compared to the local statistics.

How is it Treated?

2007-09-19T19:39:00.000-07:00

There is no cure or standard course of treatment for Bell's palsy. The most important factor in treatment is to eliminate the source of the nerve damage.

Bell's palsy affects each individual differently. Some cases are mild and do not require treatment as the symptoms usually subside on their own within 2 weeks. For others, treatment may include medications and other therapeutic options.

Recent studies have shown that steroids are an effective treatment for Bell's palsy and that an antiviral drug such as acyclovir-used to fight viral infections-combined with an anti-inflammatory drug such as the steroid prednisone-used to reduce inflammation and swelling-may be effective in improving facial function by limiting or reducing damage to the nerve. Analgesics such as aspirin, acetaminophen, or ibuprofen may relieve pain. Because of possible drug interactions, patients 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. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.

Physical therapy to stimulate the facial nerve and help maintain muscle tone may be beneficial to some. Facial massage and exercises may help prevent permanent contractures (shrinkage or shortening of muscles) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce pain.

Other therapies that may be useful for some individuals include relaxation techniques, acupuncture, electrical stimulation, biofeedback training, and vitamin therapy (including vitamin B12, B6, and zinc), which may help nerve growth.

In general, decompression surgery for Bell's palsy -to relieve pressure on the nerve-is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage such as an eyelid that will not fully close or a crooked smile.

How is it Diagnosed?

2007-09-19T19:37:00.000-07:00

A diagnosis of Bell's palsy is made based on clinical presentation-including a distorted facial appearance and the inability to move muscles on the affected side of the face-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. In most cases this weakness is limited to one side of the face or occasionally to the forehead, eyelid, or mouth. A test called electromyography (EMG) can confirm the presence of nerve damage and determine the severity and the extent of nerve involvement. An x-ray of the skull can help rule out infection or tumor. A magnetic resonance imaging (MRI) or computed tomography (CT) scan can eliminate other causes of pressure on the facial nerve.

Who Gets it?

2007-09-11T22:56:00.003-07:00

Bell's palsy afflicts approximately 40,000 Americans each year. It affects men and women equally and can occur at any age, but it is less common before age 15 or after age 60. It disproportionately attacks pregnant women and people who have diabetes or upper respiratory ailments such as the flu or a cold.

What Causes Bell's Palsy?

2007-09-11T22:56:00.001-07:00

Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown.

Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus - herpes simplex - causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the Fallopian canal and leading to an infarction (the death of nerve cells due to insufficient blood and oxygen supply). In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.

The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.

What are the Symptoms?

2007-09-11T22:55:00.001-07:00

Because the facial nerve has so many functions and is so complex, damage to the nerve or a disruption in its function can lead to many problems. Symptoms of Bell's palsy, which vary from person to person and range in severity from mild weakness to total paralysis, may include twitching, weakness, or paralysis on one or both sides of the face, drooping of the eyelid and corner of the mouth, drooling, dryness of the eye or mouth, impairment of taste, and excessive tearing in one eye. Most often these symptoms, which usually begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.

Other symptoms may include pain or discomfort around the jaw and behind the ear, ringing in one or both ears, headache, loss of taste, hypersensitivity to sound on the affected side, impaired speech, dizziness, and difficulty eating or drinking.

Understanding Bell's Palsy

2007-09-11T22:54:00.000-07:00

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to one of the two facial nerves. The facial nerve-also called the 7th cranial nerve-is a paired structure that travels through a narrow, bony canal (called the Fallopian canal) in the skull, beneath the ear, to the muscles on each side of the face. For most of its journey, the nerve is encased in this bony shell.

Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the stapes. The facial nerve also transmits taste sensations from the tongue.

When Bell's palsy occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or paralysis.

Bell's palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who was the first to describe the condition. The disorder, which is not related to stroke, is the most common cause of facial paralysis. Generally, Bell's palsy affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides.

Why Me?

2007-09-11T20:34:00.000-07:00

I felt is something is wrong with my face, but I cant tell what it is. When we left the park and went to my mother in law's house, I was alarmed by their reaction: they rushed over me as if I am very sick. They asked if I had a sort of stroke. They called the nurse neighbor and asked her to get my blood pressure. They asked me if I'm in pain. I said no. I asked why. Then they gave me the mirror. For the first time in my life, I never felt so afraid--for myself.
My left face was paralyzed. My left eye was not closing. When i speak, the left side of my lips were not moving. My right cheek was moving with every expression I make but my left cheek was not. Then I cried. I cried really hard because I cannot imagine me, in my 23 years of existence, suffering such experience. I cried because that experienced robbed the beauty and youth off my face. And because of that I could not face anybody anymore. How can I get to work? what will people think of me?