Scenario: Bell’s palsy

Practice Scenarios

Scenario: Bell’s palsy

In Practice Scenarios

Pharmacist Parveen is talking to Paul Odley, who is usually a regular customer but hasn’t been in for a couple of weeks...

“We missed you, Paul,” says Parveen. “Have you been on holiday?” “Chance would be a fine thing!” replies Paul. “My Barbara has been really poorly. I thought she had had a stroke because one side of her face was drooping, so I took her straight to A&E. They said it was something called Bell’s palsy and gave her some tablets — she had to take six every morning — and some eye drops. She’s finished the tablets and while she’s a bit better — she can close that eye now, which is a great relief — it’s not gone. She’s very self-conscious about her appearance. Is this as good as it is going to get?”

Answer

The prognosis for Bell’s palsy is actually pretty good, with over 70 per cent of sufferers expected to make a full recovery within three to six months or longer.

A little more than 10 per cent will generally get back to near normal, but around 15 per cent are left with ongoing symptoms.

This is usually due to more significant damage occurring in the first place, which is more likely in individuals who develop the condition at a more advanced age, have more severe symptoms at onset (for example, complete rather than partial paralysis, and high levels of pain), or had a pre-existing condition such as diabetes or pregnancy.

There is also a small proportion who experience recurrent Bell’s palsy.

Taking a high dose of prednisolone within 72 hours of symptoms starting – as Barbara sounds to have done from Paul’s description – has been shown to improve the likely prognosis.

The bigger picture

Bell’s palsy is the commonest cause of acute facial paralysis, affecting between 20 and 40 people per 100,000 in this country every year. It is most common between the ages of 15 and 60 years, and incidence appears to be higher during the winter.

The cause is unclear, but the symptoms stem from inflammation around, and therefore compression of, the facial nerve. As well as causing paralysis of one half of the face, symptoms can include impaired sense of taste, sensitivity to loud noises, difficulty eating and speaking, drooling and rhinorrhoea.

Complications that can occur as a result of prolonged symptoms include contracture of the facial muscles on the affected side of the face, involuntary eye watering, lagophthalmos, synkinesia and psychological problems; for example, anxiety and depression.

Extend your learning

• Bell’s palsy has a similar presentation to stroke. Three simple tests that can help you differentiate between the two can be found at nhs.uk/conditions/bells-palsy
• Do you know what lagophthalmos and synkinesia are? Check your understanding at facialpalsy.org

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