7 Key Bell’s Palsy Symptoms You Need to Know

Bell’s palsy is a condition that causes sudden weakness or paralysis of the muscles on one side of the face. This temporary facial paralysis occurs when the facial nerve (7th cranial nerve) becomes inflamed, compressed, or swollen. Understanding the symptoms of Bell’s palsy is crucial for early detection and prompt medical intervention, which can significantly improve recovery outcomes.

The condition typically develops rapidly, often overnight, and most people notice the symptoms when they wake up in the morning or when trying to eat or drink. While Bell’s palsy can be alarming, recognizing its characteristic signs can help you seek appropriate medical care quickly. Let’s explore the key symptoms that define this condition.

1. Sudden Facial Weakness or Paralysis

The hallmark symptom of Bell’s palsy is rapid onset of weakness or complete paralysis on one side of the face. This typically develops within hours to a few days and affects one side exclusively, though in rare cases both sides may be involved.

The facial weakness makes it difficult to control the muscles responsible for facial expressions. You may notice that one side of your face appears to “droop” or feel heavy. This paralysis affects the upper and lower portions of the face, distinguishing it from other types of facial weakness like those caused by stroke, which typically spare the forehead.

What you might experience:

• Inability to close one eye completely
• Difficulty smiling or frowning on the affected side
• One side of the face appears flat or expressionless
• Loss of the nasolabial fold (the crease that runs from nose to corner of mouth)
• Difficulty with facial movements such as wrinkling the forehead or puffing out the cheeks

2. Drooping of the Mouth and Eyelid

One of the most visible symptoms of Bell’s palsy is the drooping of facial features on the affected side. The corner of the mouth sags downward, and the eyelid on that side may not close properly or may droop significantly.

This drooping occurs because the facial nerve controls the muscles responsible for maintaining the normal position and movement of these features. When the nerve is compromised, these muscles lose their tone and ability to contract normally.

Specific manifestations include:

• The affected eyelid may remain partially or completely open, even during sleep
• Difficulty blinking, which can lead to eye dryness and irritation
• The mouth pulls toward the unaffected side when attempting to smile
• Drooling from the corner of the mouth on the affected side
• Difficulty keeping liquids in the mouth while drinking

3. Changes in Taste Sensation

Many people with Bell’s palsy experience alterations in their sense of taste, particularly on the front two-thirds of the tongue on the affected side. This occurs because the facial nerve carries taste fibers from the anterior portion of the tongue.

The taste disturbance can range from a diminished ability to taste to complete loss of taste sensation. Some individuals describe foods tasting bland, metallic, or simply different than usual. This symptom can significantly impact appetite and eating enjoyment during the recovery period.

Taste-related symptoms may include:

• Reduced ability to distinguish between sweet, salty, sour, and bitter tastes
• Food tasting unusually bland or flavorless
• Metallic or altered taste sensations
• Difficulty enjoying previously favorite foods

4. Increased Sensitivity to Sound (Hyperacusis)

Hyperacusis, or increased sensitivity to sound in the ear on the affected side, is a less commonly discussed but significant symptom of Bell’s palsy. This occurs because the facial nerve also supplies a small muscle in the middle ear called the stapedius, which helps dampen loud sounds.

When the facial nerve is impaired, this protective mechanism fails, causing normal sounds to seem uncomfortably or even painfully loud. This symptom typically affects the ear on the same side as the facial paralysis.

You might notice:

• Ordinary sounds appearing much louder than normal
• Discomfort or pain when exposed to everyday noises
• Difficulty tolerating environments with background noise
• Sounds seeming to echo or distort in the affected ear
• Particular sensitivity to high-pitched sounds

5. Pain Around the Jaw or Behind the Ear

Pain or discomfort around the ear, jaw, or back of the head on the affected side is frequently reported by people with Bell’s palsy. This pain often precedes or accompanies the onset of facial weakness and can be one of the first warning signs of the condition.

The pain is thought to result from inflammation and swelling of the facial nerve as it passes through a narrow bony canal within the skull. The discomfort can range from mild to severe and may persist for several days.

Pain characteristics include:

• Aching sensation behind the ear on the affected side
• Pain in the jaw or temporomandibular joint area
• Headache, particularly around the ear or temple
• Increased discomfort with jaw movement or chewing
• Tenderness when touching the area behind the ear

6. Excessive Tearing or Dry Eye

Eye problems are common in Bell’s palsy due to the inability to blink normally and close the eyelid completely. Paradoxically, patients may experience either excessive tearing or dry eye symptoms, and sometimes both.

When the eyelid cannot close properly, the eye’s surface becomes exposed and can dry out. In response, the eye may produce excess tears as a protective mechanism. However, these tears may not spread evenly across the eye due to impaired blinking, leading to both dryness and overflow of tears.

Eye-related symptoms include:

• The affected eye producing more tears than usual
• Tears running down the cheek (epiphora)
• Dry, gritty sensation in the affected eye
• Redness and irritation of the eye
• Increased sensitivity to light
• Blurred vision due to tear film instability
• Risk of corneal damage if the eye remains unprotected

7. Difficulty with Eating, Drinking, and Speaking

The facial weakness associated with Bell’s palsy significantly impacts daily activities such as eating, drinking, and speaking. The loss of muscle control on one side of the face creates practical challenges that can be frustrating and socially uncomfortable.

These difficulties arise because normal facial muscle coordination is essential for controlling food and liquid in the mouth, articulating speech sounds clearly, and managing saliva. The affected side cannot participate in these activities normally, placing extra burden on the unaffected side.

Common challenges include:

• Food collecting between the teeth and cheek on the paralyzed side
• Liquid leaking from the corner of the mouth when drinking
• Difficulty chewing, especially solid foods
• Drooling, particularly during sleep or when leaning forward
• Slurred or unclear speech, especially with certain consonants
• Difficulty pronouncing “p,” “b,” and “m” sounds that require lip closure
• Need to eat more slowly and carefully
• Preference for soft foods that require less chewing

Main Causes of Bell’s Palsy

While the exact cause of Bell’s palsy remains unclear in many cases, researchers have identified several factors that may contribute to the development of this condition. Understanding these potential causes can help in recognizing risk factors and possibly preventing some cases.

Viral Infections

The most widely accepted theory is that Bell’s palsy results from viral infections that cause inflammation and swelling of the facial nerve. Several viruses have been implicated:

• Herpes simplex virus (HSV): The same virus that causes cold sores is believed to be the most common viral trigger
• Varicella-zoster virus: The virus responsible for chickenpox and shingles
• Epstein-Barr virus: The virus that causes mononucleosis
• Cytomegalovirus: A common herpes virus
• Respiratory viruses: Including adenoviruses and influenza

Immune System Response

Bell’s palsy may result from an abnormal immune system response following a viral infection. The body’s immune system may inadvertently attack the myelin sheath covering the facial nerve, leading to inflammation and temporary paralysis.

Nerve Compression

The facial nerve passes through a narrow bony canal in the skull called the fallopian canal. When the nerve becomes inflamed and swells, this confined space creates compression that interrupts normal nerve signals, resulting in facial paralysis.

Risk Factors

Certain conditions and circumstances increase the likelihood of developing Bell’s palsy:

• Pregnancy: Particularly during the third trimester or shortly after delivery
• Diabetes: People with diabetes are at higher risk
• Upper respiratory infections: Recent colds, flu, or other respiratory infections
• Family history: Having relatives who have had Bell’s palsy
• Age: While it can occur at any age, it’s most common between 15 and 60 years
• Preeclampsia: High blood pressure during pregnancy
• Obesity: Excess weight may increase risk

Frequently Asked Questions

What is Bell’s palsy?

Bell’s palsy is a condition that causes sudden, temporary weakness or paralysis of the muscles on one side of the face due to inflammation or compression of the facial nerve. It typically develops rapidly, often overnight, and most cases resolve within three to six months with appropriate care.

How is Bell’s palsy different from a stroke?

While both can cause facial weakness, Bell’s palsy affects both the upper and lower face on one side, including the forehead and eyelid. Stroke typically spares the forehead and is accompanied by other neurological symptoms such as arm weakness, leg weakness, speech difficulty, or confusion. If you experience sudden facial weakness, seek immediate medical attention to rule out stroke.

How quickly do Bell’s palsy symptoms appear?

Bell’s palsy symptoms typically develop rapidly, reaching peak severity within 48 to 72 hours. Many people notice symptoms when they wake up in the morning or within a few hours of onset. Some individuals may experience pain behind the ear a day or two before facial weakness appears.

Can Bell’s palsy affect both sides of the face?

While Bell’s palsy almost always affects only one side of the face, bilateral (both sides) involvement is extremely rare, occurring in less than 1% of cases. If both sides of the face are affected, doctors will typically investigate other potential causes beyond Bell’s palsy.

Will my face return to normal after Bell’s palsy?

Most people with Bell’s palsy experience significant improvement within weeks and achieve full or near-full recovery within three to six months. Approximately 70% of patients recover completely without any intervention, while about 85% recover completely with appropriate medical care. However, some individuals may experience lingering weakness or other residual effects.

When should I see a doctor for facial weakness?

You should seek immediate medical attention if you experience sudden facial weakness or paralysis. While Bell’s palsy is often the cause, sudden facial weakness can also indicate a stroke or other serious conditions. Early medical evaluation is crucial for proper diagnosis and treatment, and starting treatment for Bell’s palsy within 72 hours of symptom onset typically leads to better outcomes.

Is Bell’s palsy contagious?

No, Bell’s palsy itself is not contagious and cannot be spread from person to person. However, if a viral infection triggers the condition, that underlying virus may be contagious. The facial paralysis itself poses no risk to others.

Can stress cause Bell’s palsy?

While stress alone does not directly cause Bell’s palsy, it may weaken the immune system and make individuals more susceptible to viral infections that could trigger the condition. Some studies have suggested a possible link between high stress levels and increased risk of Bell’s palsy, though more research is needed to confirm this relationship.

Can Bell’s palsy come back after recovery?

Recurrence of Bell’s palsy is uncommon but possible. Studies suggest that approximately 8-12% of people who have had Bell’s palsy may experience a recurrence, either on the same or opposite side of the face. If facial paralysis recurs, it’s important to consult a healthcare provider for proper evaluation, as recurrent cases warrant thorough investigation.

References:

• Mayo Clinic – Bell’s Palsy
• National Institute of Neurological Disorders and Stroke – Bell’s Palsy
• NHS – Bell’s Palsy
• Johns Hopkins Medicine – Bell’s Palsy
• American Academy of Family Physicians – Bell’s Palsy