Defining, Diagnosing, and Treating Bell’s Palsy

With the recent sudden shift from summer to autumn, cold and flu season is beginning. The damp, cool, and sharp cold weather combined with more time indoors close to others allows colds and flu to spread. Also at this time of the year, we see another condition more frequently in our clinic: Bell’s palsy. While not contagious, the facial paralysis indicative of Bell’s palsy has a known correlation with cold and flu season.

What Is Bell’s Palsy?
Bell’s palsy or “idiopathic facial paralysis” is a disorder affecting the facial nerve. It causes facial muscle paralysis that is often accompanied by feelings of localized facial pain and heaviness. This facial paralysis is usually unilateral, creating an appearance of one-sided facial droop. Other symptoms include eye dryness with the inability to close the eye on the affected side, ear pain and hypersensitivity to sound, drooling, impaired speech, dizziness, headache, and impaired ability to taste. Most cases of Bell’s palsy slowly resolve between 3 and 6 months after onset, however some people experience permanent changes (sequela), such as contorted facial muscles, difficult speech, or partial blindness from scratching affected eyes. Bell’s palsy is the most common cranial nerve disease and affects an estimated 40,000 Americans each year. This disease disproportionately affects those with diabetes, colds or upper respiratory infections, and pregnant women.

What Causes Bell’s Palsy and How Is It Diagnosed?
“Idiopathic” means that the exact cause is unknown. In the case of Bell’s palsy, many neurologists suspect a strong correlation with infection of herpes simplex viruses, although this is currently still a theory. Any swelling, inflammation, or trauma to the facial nerve can elicit facial paralysis symptoms. There are no diagnostic tests to confirm the presence of Bell’s palsy, so diagnosing it requires ruling out other, often more serious conditions, such as brain tumor or stroke. For this reason, it is important to get evaluated by a trained physician at the onset of any facial droop or paralysis.

The facial nerve has four branches that each travel through different sections of the face. Bell’s palsy often affects multiple branches simultaneously, however mild cases may involve a single branch. Simple facial movement tests can discern which nerve branches are involved. Determining specific nerve branch involvement helps focus treatment and improves health outcomes.

Treatment Options: Allopathic Interventions
Antivirals: Antivirals are often prescribed due to the correlation of Bell’s palsy and herpes simplex virus, though at this time, there does not appear to be strong evidence that antiviral medications contribute to improved outcomes.

Steroids: Oral corticosteroids like prednisone are often the allopathic medicine intervention of choice to reduce the swelling and inflammation. There is mounting evidence that beginning an appropriate course of prednisone early in the onset of Bell’s palsy symptoms improves rates of full recovery. However, these steroids are not without side effects, including weight gain, nausea, acne, headache, disrupted sleep, and restlessness.

Surgery: Occasionally surgical intervention is suggested to relieve compression on the facial nerve. This option remains controversial and is rarely advised by physicians.

Physiotherapy: These therapies focus on manual manipulation of the face, moving and stretching the facial muscles to reverse muscle shrinkage and contraction from Bell’s palsy. Movement therapy may decrease the occurrence of permanent facial changes.

Eye protection: Eye patches or hydrating drops may be prescribed to maintain eye health on the affected side, especially if there is significant difficulty closing the eye.

Treatment Options: Chinese Medicine Interventions
Chinese medicine views the body holistically and treats disease based on patterns of symptoms and systems of function. In Bell’s palsy we focus on the main manifestations of paralysis, sensations of heaviness and pain, as well as underlying functional issues such as fatigue, poor sleep, and digestive dysregulation. The lack of facial function and localized pain suggest blockage of energy and Blood to the area. Using millennia of past Chinese medicine doctor’s experience and notes as guides, acupuncturists aim to restore facial function by decreasing inflammation, restoring normal circulation to the face, and supplementing the body’s normal repair mechanisms.

Acupuncture: Acupuncture is the primary therapy we use to address Bell’s palsy. With acupuncture we can directly stimulate the affected muscles as well as use distal points on the limbs to build the body’s functional resources and effect change in the face.

Electro-acupuncture: As an adjunct to acupuncture for Bell’s palsy, we often attach small electrodes to two or more needles and run small, painless pulses of electricity through them. This can directly stimulate the facial nerve branches to help reverse the symptoms of Bell’s palsy.

Moxibustion: This heat therapy can increase local circulation, boost the body’s immune system, and, if used correctly, can reduce inflammation.

Flash cupping: This therapy uses heat and glass cups to lightly and repeatedly lift the skin of the face. We use flash cupping to help relieve pressure on the facial nerve and increase circulation to the paralyzed facial muscles.

Herbal Therapy: Herbs are a wonderful tool to address both the immediate facial paralysis and any underlying patterns that delay healing. Herbal therapy is a daily stimulus to effect steady positive change, such as increasing energy, cleaning and nourishing the blood, aiding in restful sleep, or settling and rebuilding the digestion. Certain formulas can also increase circulation to the face and help speed recovery of facial muscle function.

Healing from Bell’s Palsy and Optimal Outcomes
Bell’s palsy arises spontaneously and usually resolves in 3 to 6 months without treatment. Despite this good prognosis, it is important to seek medical attention at the first sign of facial paralysis to rule out more serious conditions. Beginning treatment for Bell’s palsy in the first week of symptoms brings the best chance of full speedy recovery. Allopathic medicine and Chinese medicine practitioners both use the tools of their medicines to initiate quicker healing and decrease the chances of long lasting facial changes. Both medicines recognize that Bell’s palsy most often afflicts those with compromised immune systems. People with colds or upper respiratory infections, diabetes, overwork and fatigue, and some pregnant women are more likely to experience Bell’s palsy. The season for it is here, so some simple precautions can reduce the likelihood you will experience this disrupting condition:

1. Get enough sleep
2. Rest at home and stay warm if you catch a cold
3. Wear a scarf, especially in windy weather and cold places (even indoors!)
4. Don’t go to sleep or outside with wet or damp hair
5. If you catch a chill or feel run down, drink a warming tea like ginger and cinnamon
6. See your acupuncturist regularly to stay in peak health!

[written by Charles]

[photo by Tim Foster on Unsplash]