Bell’s Palsy (Facial Paralysis)

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 24.09.2026

What is facial paralysis?

Facial paralysis is the loss of movement on one side of the face because the facial nerve, which drives the facial muscles, has stopped working. Most people notice it in the mirror in the morning: the mouth has drooped to one side, the eye will not close, or water runs out of the corner of the mouth while drinking. Symptoms begin within hours and reach their worst within three days at most. When no specific cause can be found, the condition is called Bell’s palsy, which accounts for about 70% of all cases of facial paralysis.

How is it told apart from a stroke?

This is the first, and entirely reasonable, worry of most patients. When the facial nerve itself is affected (a peripheral palsy), the whole of that side of the face is involved: the forehead cannot be wrinkled, the eyebrow cannot be raised, the eye will not close and the corner of the mouth droops. In a stroke or other brain-related (central) cause, forehead and eyelid movement is largely preserved and only the lower half of the face is weak. If weakness of an arm or leg, slurred speech, double vision, a severe headache or loss of balance accompany the facial weakness, the problem is not Bell’s palsy and you should go to the emergency department at once.

Symptoms

One-sided facial weakness is the main sign; about half of patients notice pain behind the ear a day or two before the weakness begins. Because the eye cannot close fully, burning, watering and dryness are common, as are sounds seeming unusually loud in that ear, altered taste on the front of the tongue and food collecting in the cheek while eating. Fluid-filled blisters on the ear or in the ear canal together with severe pain point to the shingles virus (Ramsay Hunt syndrome); this form runs a more severe course and needs different treatment.

Causes: “Was it the cold?”

Facial palsy is popularly blamed on cold weather, air conditioning or a draught, but no such link has been proven scientifically. The most widely accepted explanation is that the cold-sore virus (herpes simplex), lying dormant in the nerve, reactivates and makes the nerve swell inside the narrow bony canal it passes through. The last three months of pregnancy, diabetes, high blood pressure and a recent upper respiratory infection increase the risk. Middle-ear infection, cholesteatoma, head injury and tumours of the salivary gland can also cause facial paralysis, which is why every patient has an ear examination.

Treatment

The cornerstone of treatment is a course of oral corticosteroids started within the first 72 hours of symptom onset; a course of about ten days, tapered off gradually rather than stopped abruptly, reduces swelling of the nerve and clearly raises the chance of complete recovery. In severe cases an antiviral drug may be added to the steroid; antivirals alone are not sufficient. Protecting the eye is an essential part of treatment for as long as it cannot close: lubricating drops during the day, a protective ointment at night and keeping the eye closed prevent permanent damage to the cornea. Facial muscle exercises are recommended during the recovery period.

Chances of recovery

The outlook in Bell’s palsy is generally good: in the great majority of patients improvement begins within the first three weeks, and more than 90% of those who receive steroids in time recover completely within six to nine months. Complete paralysis at the outset, older age, diabetes and a late start to treatment slow recovery. A small number of patients are left with involuntary linked movements, such as the eye narrowing when they smile (synkinesis), or a mild asymmetry; effective treatments exist for these too.

When to seek urgent care

Weakness that suddenly develops on one side of the face needs to be assessed by a doctor on the same day, both to rule out a stroke and to avoid missing the window for steroid treatment; waiting to see whether it passes is not advisable. If arm or leg weakness, slurred speech, double vision or a severe headache accompany it, call the emergency number immediately. In all other cases an ENT specialist examines the facial nerve and the ear and starts treatment.

This article is for general information; please consult your physician for diagnosis and treatment.