General Information for SLP¹s and Health Care Professionals

 

Bell¹s Palsy is an acute peripheral paralysis of the face produced by a viral immune-mediated disease.

 

Possible pathogenesis: 

After a primary infection, herpes simplex virus becomes latent in the cranial and spinal sensory ganglia.

§       Reactivation of the virus leads to replication of virus within the ganglion cells.

§       Virus travels up and down the axons, inducing an inflammatory response.

§       Results in segmental demyelination presented as nerve paralysis. 

 

 Incidence: between 15 - 40 / 100,000 population per year

 There is no sign of racial biases although there are higher instances among

 Incidence of Bell's palsy increases with age. 

 Sexual predilection:  Age 10 - 19 years, twice as common in women

 Age 40, 1.5 times more common in men.

 Pregnant women have 3.3 times more risk than nonpregnant women in the same age group. 

 

 Diabetic patients: 4.5 times more likely to develop Bell's palsy.

 A positive family history of Bell's palsy is present In 10% of the patients

 

Clinical features:

§       Sudden onset

§       Full extent of the paralysis is usually reached in 1 to 14 days. 

§       Early phase: retroauricular pain, facial numbness, epiphora, parageusia, decreased tearing, and hyperacusis.

 

Physical findings:  Unilateral Facial Paralysis

§       Hypoesthesia or dysesthesia of cranial nerves V and IX

§       Motor paresis of cranial nerves IX and X

§       Papillitis of the tongue.

 

Ramsay Hunt syndrome is a serious concern in the presence of lasting severe retroauricular (ear) pain.

 

Differential diagnosis of CN VII weakness 

§       Bells' palsy, usually unilateral, 10% bilateral

§       Differential of Unilateral Facial weakness Sarcoid

§       Lyme's disease

§       Neoplasm or mass

§       Otitis media

§       Trauma: skull fracture, facial injury

 

Prognosis

§       Recovery is complete in 60 to 90%

§       Prognostic factors:  Age: As with many pathologies younger patients have better prognoses. 

§       Incomplete paralysis tends to recover completely, as does unilateral over bilateral paresis.

§       Satisfactory recovery is achieved if it begins between 10 and 21 days.

§       Presence of systemic diseases, such as diabetes, increases chance of unsatisfactory recovery. 

 

 Medical and Prescription Drug Treatment (It is always useful to note all medcations taken by a client).

§       Acyclovir and prednisone produce better results than prednisone and placebo.

§       Steroid:  Although the benefits are debatable steroidal use is common for Bell¹s patients

as they are believed to relieve pain and reduce denervation.

§       Acyclovir (Zovirax):  Reduces pain and degree of denervation-not FDA approved for this indication.

§       Eye Care: artificial tears five times per day and to tape the eye closed during sleep.

§       Surgical Decompression: probably not beneficial.

§       Neuromuscular Retraining:  Visual feedback (mirror feedback), using a mirror to change the motor facial pattern and to reinforce proper responses.