Bell’s Palsy


What Is It?

Bell’s palsy is a weakness of the muscles on one side of the face caused by problems with a facial nerve. The nerve becomes inflamed and swollen and stops functioning properly.

There are two facial nerves, one for the right side of the face and one for the left. Each facial nerve has several branches. The main branch controls most of the muscles on one side of the face, including the muscles that control facial expression and the muscles that close and open the eyes and the lips. Other smaller branches go to the tongue and ear.

The nerve inflammation of Bell’s palsy usually is caused by a viral infection. Two types of herpes viruses, the one that causes cold sores (fever blisters) and the chickenpox virus, are believed to be likely causes. Bell’s palsy is more likely to attack people who have the flu or a cold, as well as pregnant women and people with diabetes. A less common cause of Bell’s palsy is Lyme disease.


In most cases, symptoms of Bell’s palsy begin gradually and peak in 48 hours. Early symptoms include changed sensation in a portion of the face, pain in or around the ear, increased or decreased hearing and impaired taste. As the condition progresses, a person typically has trouble closing his or her mouth and eye on one side of the face, and may complain of being unable to hold food in the mouth. The eyes also may tear more or less than usual. Pain often diminishes, but it can intensify.


Your doctor usually will be able to diagnose Bell’s palsy based on a physical examination. He or she will test for weakness in the muscles of the face, paying special attention to your ability to close both eyes and hold them closed. He or she also will ask you to smile or whistle to look for a difference on the two sides of your face. Your doctor will ask whether you are having any symptoms of numbness or weakness in other body parts or difficulty walking, symptoms not associated with Bell’s palsy.

If there are no other symptoms, and the problems are only in your face, then your doctor can diagnose Bell’s palsy without further testing. A blood sugar test may be ordered if you have not had one recently. A blood test for Lyme disease also may be done.

Expected Duration

Most symptoms go away within weeks to months.


There is no way to prevent Bell’s palsy.


If the symptoms are mild, treatment may not be necessary. Most commonly, people with Bell’s palsy are prescribed prednisone (Deltasone, Orasone and others), a corticosteroid, to reduce the inflammation and swelling in the nerve and to decrease pain. Some doctors prescribe a combination of prednisone and acyclovir (Zovirax), an oral drug that attacks the herpes virus. The medication usually is taken for 10 to 14 days.

If Bell’s palsy is affecting your ability to close your eyes, this can cause your cornea to become dry and possibly get scratched. To prevent this, you must protect your eye from wind and dust by wearing glasses. You will need to keep your eyes moist by using artificial tears frequently during the day and lubricating your eye at night with a sterile eye ointment.

When To Call A Professional

Call your doctor immediately at the first sign of decreased strength in your face, difficulty eating or drinking, or a droopy eyelid. Also call your doctor if your ear suddenly hurts, especially if you see blisters around your ear or inside your ear canal.

If you have been diagnosed with Bell’s palsy, call your doctor immediately if your eye starts hurting or feels irritated. Call if your arms or legs feel weak, your vision changes, you get dizzy, have trouble swallowing or get a headache that keeps getting worse. Contact your doctor promptly if any symptoms get worse.


Although the symptoms of Bell’s palsy are frightening, there’s a good chance that the nerve will be able to work properly again. Eighty-five percent of people with Bell’s palsy recover completely within a few months. Children almost always recover completely. Taste returns before facial strength. If taste returns within the first five to seven days of when symptoms start, it’s more likely you will recover completely. It’s also more likely you will recover completely if your facial muscles are not completely paralyzed at the most severe point of the illness.

Factors associated with a poorer outlook include a high degree of impairment, a long time before symptoms start to improve, advanced age and severe pain in or around the ear.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.