A 44-Year-Old With a Headache, Photophobia, and Phonophobia

James Lee, MD; Stephanie Oh, PhD; Gaurav Gupta, MD


November 13, 2019

No consensus has been reached regarding the benefit of or indications for surgery in the treatment of Bell palsy.[28,29] Surgical facial nerve decompression has been used as a management option to theoretically relieve the swelling and entrapment of the nerve, with such complications as seizures, vertigo, unilateral hearing loss, cerebrospinal fluid leak, and facial nerve injury.[30] Observational studies on surgical decompression have had mixed results, with some studies showing statistically significant improvement in surgical groups compared with control groups, and others showing no difference.[31,32] One systematic analysis of two randomized controlled trials found only very low-quality evidence, insufficient to decide whether surgical decompression was useful in the management of Bell palsy.[33]

In this case, the patient was advised to continue using eye drops and an eye patch, particularly at bedtime. She was also advised to continue using ibuprofen for symptomatic relief of her headache. After 6 months of conservative medical management, her symptoms persisted with only minor improvement. Serum studies and radiographic images were obtained; the findings were all unremarkable. She was subsequently referred for surgical intervention. She underwent facial nerve decompression, with near-complete resolution of her symptoms.

In conclusion, Bell palsy is a clinical diagnosis of exclusion made in patients with acute-onset, peripheral facial palsy. Although most patients experience spontaneous improvement, delay in diagnosis and treatment can significant affect quality of life. It is crucial to recognize key symptoms and initiate early treatment with corticosteroids. Prompt referral to a specialist is also important to assess for differential diagnoses and optimize recovery.


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