Fast Five Quiz: How Much Do You Know About Bell Palsy?

Medscape

22-06-2025

Bell palsy, or idiopathic facial paralysis, is the most common peripheral paralysis of the facial nerve (cranial nerve VII). Many cases of facial nerve paralysis have identifiable etiologies, such as stroke, Lyme disease, or Ramsay Hunt syndrome, but Bell palsy is, by definition, idiopathic in nature.
How much do you know about Bell palsy and its management? Check your knowledge with this quick quiz.
Type 2 diabetes is associated with several types of peripheral neuropathy, including Bell palsy. The prevalence of peripheral neuropathy among patients with type 2 diabetes has been calculated to be as high as 53.6%. In one retrospective cohort study, 33% of participants with Bell palsy had coexisting type 2 diabetes. Additionally, obesity might increase the risk for Bell palsy.
Some studies have concluded that there is a slight female preponderance among patients with Bell palsy, whereas others have found no sex predilection. Even if female sex is not a risk factor, evidence suggests that Bell palsy is associated with pregnancy.
The median age of onset is 40 years, and patient age < 15 years is not a risk factor. However, Bell palsy has been identified in children and even infants.
Facial nerve trauma can certainly cause symptoms resembling Bell palsy, but Bell palsy is idiopathic and does not have a traumatic etiology. If these symptoms resulted from trauma, the diagnosis would be traumatic facial nerve palsy rather than Bell palsy.
Learn more about Bell palsy epidemiology.
Lagophthalmos, but not true eyelid ptosis, is a characteristic feature of Bell palsy.
Symptoms of Bell palsy typically have a rapid onset, manifesting from 24 to 72 hours and often resolving or partially resolving within a few weeks to 3 months. In Bell palsy, facial paralysis is usually unilateral, and bilateral facial paralysis should lead to consideration and evaluation for other etiologies. Hearing loss is not a typical symptom of Bell palsy. The presence of hearing loss indicates an association with an upper motor neuron lesion or a lesion involving more than the facial nerve.
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A rapid evidence review on Bell palsy points out that, as the condition is idiopathic, laboratory diagnostics are not required for a diagnosis. Clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery concur that diagnostic testing is not needed to identify Bell palsy. The guidelines recommend that clinicians should not obtain routine laboratory testing in patients with new-onset Bell palsy, pointing out that this approach is not cost-effective. However, both the rapid evidence review and guidelines state that laboratory testing can help identify systemic causes of facial palsy symptoms, such as Lyme disease or diabetes, when reasonable clinical suspicion exists.
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Oral corticosteroids are recommended in a rapid evidence review as the first-line treatment for Bell palsy. Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery also recommend this approach in patients age = 16 years with Bell palsy.
Antiviral monotherapy has not been demonstrated to influence recovery and should be avoided. However, combination therapy with oral corticosteroids and antivirals should be considered, as this approach consistently results in lower rates of synkinesis and might reduce rates of incomplete recovery.
Local injectable anesthetic would not be an appropriate therapy because it would not address the underlying cause, lower motor neuron palsy. There is no evidence-based role for local anesthetic in the treatment of Bell palsy.
Electroconvulsive therapy is mostly used in the treatment of severe mood disorders. The mechanism of action would not be expected to be useful in the treatment of facial nerve palsy.
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Along with the Sunnybrook facial grading system, the House-Brackmann scale is widely used to qualify symptom severity of Bell palsy. A patient with obvious facial weakness, inability to move the forehead, incomplete closure of the eyelids, and mouth asymmetry with maximal effort would be grade IV, moderately severe symptoms.
Grade I is classified as a normal presentation with full facial function in all areas. Grade II is characterized by slight facial weakness on close inspection, slight synkinesis, and no lagophthalmos. Grade III would exhibit moderate symptoms with noticeable, but not severe, synkinesis; obvious facial asymmetry but not disfiguring; complete eyelid closure with effort; and slightly weak mouth even with maximal effort.
Learn more about Bell palsy prognosis.