|  | Conditions Treatments | Neurological Disorders

Bell's Palsy Differential Diagnosis

Bell's palsy is characterized by short-term facial paralysis caused by some form of trauma to one of the facial nerves. There are two of these nerves; each is responsible for controlling the muscles on the face (one controls the right half, the other controls the left). This encompasses functions like blinking, smiling and frowning. Usually, only one of the nerves is affected; thus, only one side of the face is generally impaired.

  1. What Else Could It Be?

    • In making a differential diagnosis, your doctor must rule out other conditions which can mimic that of Bell's palsy. For example, lesions on the parotid gland or in the ear can compress the facial nerve and cause paralysis. There are several other palsies of the peripheral nerves like Lyme disease, Guillain-Barré syndrome, Ramsay Hunt syndrome (herpes zoster affecting the facial nerve), otitis media, sarcoidosis and even some flu vaccines.

    Symptoms of Bell's Palsy

    • Symptoms of Bell's palsy include paralysis on one side of the face, paralysis on both sides of the face (rare occurrence), paralysis of the eyelid, pain in the face, altered taste, stiff neck, low-grade fever, hypersensitivity to sound in one ear, pain behind one ear and weakness and/or stiffness of the face. Additional symptoms include problems with closing your mouth, eating and speaking. Drooling and increased tearing of the eye may occur as can dryness of the eye or reduced salivation.

    How to Differentiate from Other Conditions

    • To make a differential diagnosis, you must examine how the other potential conditions which could cause facial paralysis differ from the symptoms of Bell's palsy. These conditions usually involve additional characteristics. For example,
      tumors and lesions usually present with additional dangerous symptoms over a period of time. Lyme disease is characterized by exposure to ticks, joint pain and rash. Otitis media generally is characterized by a gradual onset of symptoms with fever and ear pain being predominant symptoms. Ramsay Hunt syndrome is often preceded by pain and often involves the vesicles of the pharynx and ear canal. Guillain-Barré Syndrome involves both nerves and often affects other areas of the body. And sarcoidosis usually involves lymph nodes, skin and bones and tends to involve both of the facial nerves.

    Additional Tests

    • An EMG (electromyography) can help to confirm any possible nerve damage. X-rays of the skull will determine if a tumor or infection is the cause of the paralysis. Finally, an MRI (magnetic resonance imaging) or CT (computed tomography) scan can be helpful in ruling out other conditions which may create pressure on the nerve.

    Treatment

    • Bell's palsy has no cure. Treating it focuses on eradicating the cause of the nerve damage. According to the Journal of the American Academy of Family Physicians, clinical treatment recommendations are to treat patients with confirmed cases of Bell's palsy within 3 days of the becoming symptomatic with a one-week course of acyclovir or valacyclovir (taken orally) plus a short course of prednisone (also taken orally). Your doctor may additionally recommend over-the-counter pain relievers like ibuprofen, acetaminophen or aspirin to relive discomfort. Because the condition often affects the eye's ability to produce tears and to blink, protecting the eye with drops (like artificial tears) or patches may be additionally recommended.

      Some patients may require physical therapy to preserve facial muscle tone and help to stimulate the nerve. Specific massage technique and exercise of the face can help to prevent any permanent damage to the facial muscles.

Neurological Disorders - Related Articles