Bell’s Palsy

Also indexed as: Facial Nerve Palsy, Facial Paralysis

When one side of the face suddenly feels weak and numb, a nerve disorder may be the underlying reason. According to research or other evidence, the following self-care steps may help people with Bell’s palsy:

Get a check-up
Visit your healthcare professional to find out if you have a disease, such as diabetes or hypertension, that is associated with Bell’s palsy

Consider vitamin B12 injections
Consult a doctor knowledgeable in the use of vitamin B12 injections to find out if this treatment will speed your recovery

Discover HBT
Consult a doctor knowledgeable in the use of hyperbaric oxygen therapy to find out if this procedure may quicken your recovery

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full Bell’s palsy article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Bell’s palsy is a disorder of the nerve that controls certain muscles of the face.

People with Bell’s palsy lose control of some or all of the muscles on one half of the face; consequently, the face looks asymmetrical. Rarely are both sides of the face affected. The cause is unknown, and the disorder usually resolves without treatment within six to twelve months.

People with diabetes or hypertension have greater-than-average risk for Bell’s palsy.¹ ² ³ While no research has investigated whether better control of these conditions may help prevent Bell’s palsy, people with Bell’s palsy should be checked for diabetes and hypertension, especially if the palsy occurs repeatedly or affects both sides of the face.

Product ratings for Bell's Palsy

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	Vitamin B12 (injections)
See also: Homoeopathic Remedies for Bell’s palsy
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Some common symptoms of Bell’s palsy include a rapid onset of weakness, numbness, heaviness, or paralysis of one side of the face. People with Bell’s palsy may also have symptoms of pain behind the ear, inability to completely close one eye, drooling, and speech difficulties.

Medical options

Over the counter treatment with artificial tear solutions might help with symptoms involving the eye. Drugs used include polyvinyl alcohol (Hypotears®, Murine®, Liquifilm Tears®), hydroxypropyl methylcellulose (LubriTears®, Tears Naturale Free®, Moisture Drops®), and carboxymethylcellulose (Refresh Plus®, Celluvisc®).

Prescription drug therapy involves the use of steroids, such as prednisone (Deltasone®), methylprednisolone (Medrol®), and prednisolone (Prelone®, Pediapred®).

Skin tape or an eye patch may be used to help the eye stay closed and lubricated. Difficult cases may require a surgical procedure in which the eyelids are stitched together.

Vitamins that may be helpful

Vitamin B12 deficiency can cause nerve degeneration,⁴ and both oral⁵ and injected⁶ ⁷ vitamin B12 have been used to treat many types of nerve disorders.⁸ One older case report described successful treatment of chronic Bell’s palsy with vitamin B12 injections of 500 to 1,000 mcg given every one to two days.⁹ A more recent trial compared the effect of 500 mcg of injected vitamin B12 (in the form of methylcobalamin) given three times weekly for at least eight weeks—steroid medication, or both. Researchers found significantly faster recovery in the groups given B12 injections with or without steroids, compared to those given steroids alone.¹⁰ These findings agree with earlier reports on the effectiveness of methylcobalamin injections for Bell’s palsy.¹¹ ¹² It is unlikely that oral vitamin B12 would be similarly effective. People seeking B12 injections should consult a physician.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Integrated approaches that may be helpful

Many reports claim that acupuncture speeds recovery from Bell’s palsy,¹³ ¹⁴ ¹⁵ ¹⁶ but no controlled trials have been done to confirm this is neither a placebo effect nor the natural course of healing.

Hyperbaric oxygen therapy (HBT) is a procedure in which the patient breaths 100% oxygen at pressures up to three times greater than normal atmospheric pressure. A well controlled study of Bell’s palsy patients compared HBT plus a placebo tablet with fake oxygen therapy plus steroid medication.¹⁷ HBT produced significantly faster recovery (22 vs. 34 days) compared to the use of steroids.

Biofeedback techniques (using simple electronic devices to measure and report information about a person’s biological system) have been reported to help limit the deterioration of muscle function and speed recovery in Bell’s palsy.¹⁸ ¹⁹ However, a controlled trial of patients with chronic facial paralysis (including some with Bell’s palsy) found that using a mirror as feedback was as effective as a mirror plus electrical biofeedback for improving facial symmetry and muscle function.²⁰

References
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1. Adour K, Wingerd J, Doty HE. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell’s palsy). Diabetes 1975;24:449–51.

2. Yanagihara N, Hyodo M. Association of diabetes mellitus and hypertension with Bell’s palsy and Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol Suppl 1988;137:5–7.

3. Brandenburg NA, Annegers JF. Incidence and risk factors for Bell’s palsy in Laredo, Texas: 1974–1982. Neuroepidemiology 1993;12:313–25.

4. Savage DG, Lindenbaum J. Neurological complications of acquired cobalamin deficiency: clinical aspects. Baillieres Clin Haematol 1995;8:657–78 [review].

5. Yaqub BA, Siddique A, Sulimani R. Effects of methylcobalamin on diabetic neuropathy. Clin Neurol Neurosurg 1992;94:105–11.

6. Ide H, Fujiya S, Asanuma Y, et al. Clinical usefulness of intrathecal injection of methylcobalamin in patients with diabetic neuropathy. Clin Ther 1987;9:183–92.

7. Kuwabara S, Nakazawa R, Azuma N, et al. Intravenous methylcobalamin treatment for uremic and diabetic neuropathy in chronic hemodialysis patients. Intern Med 1999;38:472–5.

8. Yamane K, Usui T, Yamamoto T, et al. Clinical efficacy of intravenous plus oral mecobalamin in patients with peripheral neuropathy using vibration perception thresholds as an indicator of improvement. Curr Ther Res 1995;56:656–70 [review].

9. Mitra M, Nandi AK. Cyanocobalamin in chronic Bell’s palsy. J Indian Med Assoc 1959;33:129–31.

10. Jalaludin MA. Methylcobalamin treatment of Bell’s palsy. Methods Find Exp Clin Pharmacol 1995;17:539–44.

11. Kobayashi H, Aoyagi M, Suzuki H, et al. The clinical effects of mecobalamin on peripheral facial palsy. Otolaryngology 1980;26:968–72.

12. Yagi N, Ishikawa Y, Fukazawa T. The effect of steroid and CH3 vitamin B12 on peripheral facial paralysis. Otologia Fukuoaka 1981;74:1613.

13. Zhang Y. Clinical experience in acupuncture treatment of facial paralysis. J Tradit Chin Med 1997;17:217–9.

14. He S, Zhang H, Liu R. Review on acupuncture treatment of peripheral facial paralysis during the past decade. J Tradit Chin Med 1995;15(1):63–7 [review].

15. Yuan H, Zhang J, Feng X, Lian Y. Observation on electromyogram changes in 93 cases of peripheral facial paralysis treated by point-through-point acupuncture. J Tradit Chin Med 1997;17:275–7.

16. Zang J. 80 cases of peripheral facial paralysis treated by acupuncture with vibrating shallow insertion. J Tradit Chin Med 1999;19:44–7.

17. Racic G, Denoble PJ, Sprem N, et al. Hyperbaric oxygen as a therapy of Bell’s palsy. Undersea Hyperb Med 1997;24:35–8.

18. Biedermann HJ, Inglis J. The restoration of control in facial muscles affected by Bell’s palsy. Int J Psychosom 1990;37:73–7.

19. Lobzin VS, Tsatskina ND. The adaptive biological control system with electromyographic feedback in the treatment of Bell’s palsy. Zh Nevropatol Psikhiatr Im S S Korsakova 1989;89(5):54–7 [in Russian].

20. Ross B, Nedzelski JM, McLean JA. Efficacy of feedback training in long-standing facial nerve paresis. Laryngoscope 1991;101:744–50.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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What are the symptoms?

Medical options

Vitamins that may be helpful

Integrated approaches that may be helpful