Bell's Palsy

Question 1

Bell’s Palsy

Answer 1

Neurological condition of rapid-onset unilateral facial paralysis.
An upper motor neurone pathology.

Question 2

Aetiology of Bell’s Palsy

Answer 2

Not 100% certain on mechanism.
?Inflammation/oedema of facial nerve CN7

Question 3

Clinical features of Bell’s Palsy

Answer 3

• unilateral facial paralysis (not forehead sparing)
• may have ear pain
• may have loss of taste anterior tongue
• may have hyperacusis

Question 4

Investigating Bell’s Palsy

Answer 4

Diagnosis of exclusion, ensure no:
- forehead sparing
- swelling or masses (e.g. parotids)
- other CN or neurological abnormalities

Question 5

Differentials for Bell’s palsy

Answer 5

• stroke/TIA
• brain tumour or mets
• infections: Ramsay hunts, lyme disease

Question 6

Managing Bell’s Palsy

Answer 6

• reassure most cases self-resolve
• prednisolone if presents in 72 hours post-onset
• antivirals if pathology severe (not monotherapy)
• good eye care (lubricants, taping over night)
• nutrition important (straw and soft diet)
• no improvement in 3 weeks -> ENT