Nursing Continue Education

Bell’s palsy / Reading and Sharing

Bell’s palsy is a medical disease that has a cause of an unknown origin. It can be very scary for many patients as it results in one sided facial paralysis which can mirror stroke symptoms at first glance (Hultcrantz, 2016). If affects nearly 25-30 people per 100,000 per year and about 70% of all cases have their facial movement restored. It affects males and females equally with an average age of 70 years old. Some of the risk factors are older age, pregnancy and diabetes and it is believed that Bell Palsy is caused by viral inflammation and immune response (Ferri, 2017).

The pathophysiology of Bell Palsy is up for debate. The facial nerves run through the temporal bone also called the facial canal. It has been theorized that localized edema and ischemia in the facial canal leads to compression of the facial nerves which then leads to facial paralysis. This can be confirmed by MRI of the face that shows facial nerve compression. (Taylor, 2017).

The facial nerve, cranial nerve VII, is affected which is why the person experiences sensory and motor deficits (Winland-Brown & Keller, 2015). Even though the cause is unknown, it is thought that most cases are caused from a viral infection. It is felt that it may be caused from the herpes simplex infection of the geniculate ganglion or the varicella-zoster virus by demyelinating the nerve causing severe pain and hearing loss (Winland-Brown & Keller, 2015). It can take on average 3 to 6 months to recover from Bell’s palsy but can be as long as 12 months (Winland-Brown & Keller, 2015). Depending on how the facial nerve is affected would determine how the symptoms may present.

Therefore, the symptoms of Bell’s palsy can vary person to person. The symptoms can be severe or mild. The typical symptoms can be facial twitching, weakness, paralysis on one side. Eyelid, mouth drooping, eye and mouth dryness, excessive tearing in the one eye, taste irregularities, ear ringing, headache, impaired speech sometimes (NIH, 2017). These symptoms come on sudden and peak after 48 hours (NIH, 2017).

The patient will not be able to raise the eyebrow, wrinkle the forehead, close the eyelid, whistle, or retract the muscles of the mouth or chin (Winland-Brown & Keller, 2015). The tongue can deviate, and they have a difficult time talking, needing to puff cheeks and purse the lips to compensate (Winland-Brown & Keller, 2015). If the provider cannot complete concluding the diagnosis is Bell’s palsy based on the presentation and patient’s history, and then a CT scan or MRI can be performed. In addition, an electromyography can help determine the extent of the nerve involvement (Winland-Brown & Keller, 2015).

Evidence-Based Treatment Plan & Outcomes

Usually, treatment for Bell’s palsy is more supportive because the condition will gradually heal on its own (Winland-Brown & Keller, 2015). If the patient cannot blink, then preventing eye injury would be appropriate care. An eye patch may help protect the eye along with lacri-lube at night and artificial tears during the day (Ferri, 2018; Winland-Brown & Keller, 2015). If medication is started, it should be initiated as soon as the diagnosis is made. Corticosteroids can help speed up the recovery time if started within 72 hours of symptoms (Ferri, 2018). Prednisone 60 to 80 mg daily for 1 week is the recommended treatment guidelines (Ferris, 2018). There is a debate on whether or not starting the patient on an antiviral would be beneficial such as valacyclovir (Ferri, 2018). If the patient is experiencing ear pain, then having them take an over-the-counter medication for pain such as acetaminophen or ibuprofen would be appropriate (Winland-Brown & Keller, 2015). Regular interval follow-ups would be needed to assess for improvement or deterioration if after 6 months, there are no improvements in their symptom or there are other neurological signs appearing, then a referral to a neurologist would be necessary (Winland-Brown & Keller, 2015).

Reassurance to the patient and family with this condition is important. Initially, there can be shock and stress due to the loss of function on that side of the face. It can cause increased anxiety and self-esteem issues until it is resolved. Some things that may help the patient cope would be to have to wear make-up or have them wear their hair in a way in which would minimize the facial appearance (Winland-Brown & Keller, 2015). Also drinking from a bottle versus a glass may be easier. Educating the patient about appropriate eye care and oral hygiene is important. The chewing is impaired, so food can get trapped in the mouth. Softer foods would be safer due to less risk of choking from not chewing food appropriately (Winland-Brown & Keller, 2015). Once the strength is regained, facial exercises and massages can be started (Winland-Brown & Keller, 2015).

References:

Ferri, F. F. (2018). 2018 Ferri’s clinical advisor. (pp. 147-148). Philadelphia, PA: Elsevier, Inc.

Hultcrantz, M. (2016). Rehabilitation of Bells’ palsy from a multi-team perspective. Acta Oto-Laryngologica, 136(4), 363-367. doi:10.3109/00016489.2015.1116124

National Institute of Health. (2017). Bell’s palsy fact sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Bells-Palsy-Fact-Sheet

Winland-Brown, J. E. & Keller, M. B. (2015). Neurological problems. In L.M. Dunphy, J. E. Winland-Brown, B. O. Porter, & D. J. Thomas (Eds.), Primary care: The art and science of advanced practice nursing (4th ed., pp. 77-148). Philadelphia, PA: F. A. Davis Company.

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