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Bell's palsy - Treating Bell's palsy

NHS Choices Medical Reference

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Most people recover fully from Bell's palsy without treatment, but there are ways to accelerate the process and reduce the chance of complications.

Medication

In recent years, there has been some disagreement among healthcare professionals about whether Bell's palsy can be most effectively treated using steroids, antiviral medications, or a combination of both.

However, recent evidence suggests that a steroid called prednisolone is the most effective treatment for Bell's palsy, and that it should be administered within 72 hours of the symptoms appearing. There is little evidence to suggest that additional antivirals accelerate facial muscle recovery.

Prednisolone

Prednisolone works by helping to reduce inflammation (swelling), which should also help to speed up your recovery. In most cases, people with Bell's palsy are advised to take prednisolone tablets twice a day for a period of 10 days.

Possible side effects of prednisolone include:

  • nausea (feeling sick)
  • headache
  • increased sweating
  • indigestion
  • increased appetite
  • difficulty sleeping
  • oral thrush
  • dizziness

These side effects should improve within a few days as your body begins to get used to the medication.

Some people also experience mood changes, such as anxiety or depression, after taking steroids for a short period of time. You should visit your GP immediately if you experience mood changes, or if you have other side effects that are particularly troublesome.

Read more about the side effects of corticosteroids.

If you are pregnant or breastfeeding you should speak to your GP before taking prednisolone.

Read more information about oral thrush in adults.

Eye care

Tears play an important role in protecting your eyes and keeping them free of the dirt and bacteria that can cause eye infections.

If you have Bell's palsy, you might find it difficult to close your eye, which can cause your tears to evaporate and leave your eye vulnerable to infection. Therefore, it is very important to keep your eye lubricated.

Your GP may prescribe eye drops that contain 'artificial tears' for daytime use, plus an ointment that you should use at night. If you are unable to shut your eye at night time, your GP will give you some surgical tape to close your eye.

If your eye symptoms get worse, you should visit the ophthalmology department of your local hospital for assessment.

Botulinum toxin injections

Botulinum toxin (Botox) injections can be used to treat either the affected or the unaffected side of the face in people with long-term Bell's palsy.

Botox may be injected into the affected side of the face to relax any facial muscles that have become tight, or to reduce any unwanted muscle movements.

If the muscles in the unaffected side have become overactive or dominant, Botox may be injected into this side of the face to reduce muscle activity and balance the movement of the face.

Some of the long-term complications of Bell's palsy can also be treated using Botox injections. These include:

  • tears when eating, known as 'crocodile tears'
  • eye-mouth synkinesias: where the facial nerve grows back in a different way, which can lead to a winking eye when eating, smiling or laughing

Read more about the complications of Bell's palsy.

The Botox injections can help ease any discomfort that is experienced while eating and can also help to improve the overall appearance of the face. The injections need to be repeated every four months.

Further treatment

Most people with Bell's palsy will make a full recovery within nine months. However, if you have not recovered by this time, there is a risk of more extensive nerve damage and further treatment may be needed.

Physiotherapy may be recommended. Your physiotherapist will teach you a series of facial exercises that will strengthen the muscles in your face to improve their co-ordination and range of movement.

Physiotherapy has been successful in a number of Bell's palsy cases, although it may not be suitable or effective for everyone.

Plastic surgery is another possible option. The surgeon may not be able to restore nerve function, but may be able to improve the appearance and symmetry of your face.

Research has suggested that facial exercises, relaxation techniques and acupuncture can help speed up the recovery of Bell's palsy and restore facial nerve function.

Medical Review: August 11, 2012
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