Fast Five Quiz: Bell Palsy Essentials

Helmi L. Lutsep, MD


February 06, 2019

Half of patients affected with Bell palsy may complain of posterior auricular pain. The pain frequently occurs simultaneously with the paresis, but pain precedes the paresis by 2 to 3 days in about 25% of patients. Ask the patient whether he or she has experienced trauma, which may account for the pain and facial paralysis.

Facial spasm, a very rare complication of Bell palsy, occurs as tonic contraction of one side of the face. Facial spasm occurs most commonly in patients in the fifth and sixth decades of life. They are more likely to occur during times of stress or fatigue and may be present during sleep. This condition may occur secondary to compression of the root of the seventh nerve by an aberrant blood vessel, tumor, or demyelination of the nerve root. Sometimes the etiology is not found.

The onset of Bell palsy is typically sudden, and symptoms tend to peak in less than 48 hours. This sudden onset can be frightening for patients, who often fear they have had a stroke or have a tumor, and that the distortion of their facial appearance will be permanent.

Early symptoms include the following:

  • Weakness of the facial muscles

  • Poor eyelid closure

  • Aching of the ear or mastoid (60%)

  • Alteration of taste (57%)

  • Hyperacusis (30%)

  • Tingling or numbness of the cheek/mouth

  • Epiphora

  • Ocular pain

  • Blurred vision

Read more information about the presentation of Bell palsy.


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