Bell’s Palsy: Comes like a thief in the night

It can happen to anyone. You wake up and you already feel that something is not quite right. Then you look in the mirror and you’re scared shitless. The sagging face makes you suspect that you may have had a brain hemorrhage. Your GP will refer you to an ENT doctor with the diagnosis of ‘Bell’s palsy’. A disease that is known to come like a thief in the night…

What is Bell’s palsy?

Bell’s palsy is a paralysis of the facial muscles. This is due to a disorder of the facial nerve. This nerve is responsible, among other things, for controlling the muscles involved in facial expression. In addition, this nerve is also important in tasting taste on certain parts of the tongue.
The nerve runs through a narrow and long canal in the skull, past the internal auditory organ, the middle ear and finally through the parotid gland. If the nerve swells, there will be insufficient space in the canal and it could become damaged.
How do you get it?
To date, it has not yet been proven, or at least not determined with certainty, what causes Bell’s palsy. The herpes simplex virus type 1 is believed to play a role. This same virus is also responsible for cold sores. Usually you have been carrying it with you for some time without knowing it. It often turns at a certain unexpected moment, possibly after a stressful situation or sometimes after major temperature changes. This can cause inflammation in the facial nerve. This will cause the nerve to swell and cause loss of function.

Other reasons for facial nerve function loss include:

  • inflammation in the middle ear;
  • damage due to an accident or operation;
  • Lyme disease, in which the Borrellia Burgdorferi bacterium is transmitted by a tick;
  • an inflammation caused by the herpes zoster virus (shingles);
  • a tumor pressing on the nerve.



Bell’s palsy involves sudden paralysis or weakness on one side of the face. This can happen at a very unexpected moment, so that some people wake up with it even though nothing had been noticed on their face the night before. Some people have pain in and around the ear for one or two days before symptoms occur.

Symptoms include:

  • a crooked face. The corner of the mouth hangs down slightly on the affected side. This hinders speaking and swallowing. Because the healthy angle moves normally, the condition is most noticeable when laughing and talking.
  • the eye on the affected side is wide open and it is not possible to close it completely.
  • sometimes pain is experienced behind or in front of the ear on the affected side;
  • sometimes the taste is reduced at the front of the tongue.

The damage can be complete or localized. With partial paralysis, the facial muscles are still able to move somewhat. However, partial paralysis can still develop into complete facial paralysis after a few days. Although the tight and contorted facial expression often disappears after a while, the risk of a permanent deformity remains.


The diagnosis of Bell’s palsy is based on the patient’s history and is followed by a clinical examination by the ENT (Ear, Nose and Throat). Other matters must first be completely ruled out and that is why additional research is often carried out. This may involve counting the number of blood cells to a CT scan of the head.


Sometimes recovery is accelerated by using medicines such as prednisone and antiviral agents. If the eyes cannot be closed completely, drops or a gel are prescribed. At night, the eyes are taped up to prevent the cornea from drying out. If this does not go away, in some cases plastic surgery is used to prevent drying of the eye.
In addition, some patients benefit from physiotherapy, exercise therapy, speech therapy and/or occupational therapy.

Chance of recovery

About 70 to 80 percent of patients recover spontaneously within two to twelve weeks. However, in older cases with complete facial paralysis, the prognosis is much worse, it may go away partially or not at all and it remains a permanent disability.


Some possible complications include:

  • facial deformity;
  • damage to the eye;
  • prolonged twitching in the facial muscles or eyelids;
  • an abnormal or no taste perception.

In some cases, the facial nerve does not recover properly. As a result, unwanted movements may occur: the eye and closing when the mouth closes or lacrimation during salivation (crocodile tears). A small number of patients will later be confronted with Bell’s palsy again.

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