Bells Palsy: Beware…….. Exposure to cold in winters can cause Paralysis of Face!

Many patients nowadays come with a complaint which is increasingly being very commonly seen in WINTERS which is —-

BELLS PALSY aka PARALYSIS OF ONE SIDE OF FACE

WHAT IS IT CALLED?

The sudden onset of complete/partial paralysis of one side of the face is called “BELLS PALSY”.

When no definite proven cause could be related to this sudden development of facial nerve paralysis it is known as BELLS PALSY.

The facial nerve is the nerve that supplies all the muscles of the face. The involvement of this nerve causes one-sided paralysis of the face.

WHO CAN BE AFFECTED BY BELLS PALSY?

– Both MALES and FEMALES are equally affected.

# FAMOUS CELEBRITIES WHO HAVE HAD BELLS PALSY are–

1) ANUPAM KHER
2) ANGELINA JOLIE
2) PIERCE BROSNAN
3) SYLVESTER STALLONE
4) GEORGE CLOONEY
5) KATIE HOLMES

  • There is no age bar but incidence rises with increasing age.
  • Risk factors include Diabetes, Pregnancy, people who work in cold, any kind of stress.

WHY DOES THIS FACE PARALYSIS OCCUR?

There are various theories that tell us why does this condition develops in the patient.

1st is a Viral infection

Many reports suggest that if a patient gets infected with Herpes simplex, Herpes zoster, or Epstein-Barr virus, may result in Bell’s palsy.

2nd is Decreased blood supply to the facial nerve.

The facial nerve is the nerve that carries all the sensation to the face.

So, if the blood supply to this nerve gets compromised due to any factor, there are very high chances that the patient will develop paralysis of the face.

This decrease in blood supply is induced very commonly by COLD (or winters).

So, the following are a few common examples that actual patients in OPDs have described to us.

These patients developed complete/partial paralysis of one side of the face when exposed to cold surroundings such as —-

a) Immediately getting out of bed in winter mornings and straightaway going out of the house without wearing anything warm, and adequately covering the face, head, and neck.

b) In winters, many of my patients come with a common history of having developed paralysis of the face from the moment they had washed their face with cold water.

c) Playing in the snow without wearing anything warm to adequately cover head, face, and neck.

d) Driving 2 wheelers (bike, scooty, scooter, etc.) in cold winters without adequately covering the face, and head with anything warm.

3rd is EMOTIONAL STRESS

STRESS causes increased leakage from walls of blood vessels that leads to a collection of fluid around the facial nerve.

And this swelling around the nerve compresses the nerve, leading to complete/partial paralysis of one side of the face.

4th is HEREDITARY

About 10% of patients give positive family history.

5th is AUTOIMMUNITY

One’s body immunity attacks own facial nerve.

6th is COVID-19 Vaccination.

News/articles have been recently published on the internet regarding the development of Facial nerve paralysis in some patients after receiving the COVID-19 vaccine (Pfizer-BioNTech).

However, till now, researchers have NOT GATHERED SUFFICIENT DATA to establish a confirmatory relationship between the vaccine and the development of facial paralysis/Bells Palsy. Researches are still going on.

CLINICAL FEATURES of BELLS PALSY —

This sudden onset of complete or incomplete isolated one-sided facial palsy may present with the following features:

1. Inability to completely close eye on the side of paralysis.

2. Less blinking of the eye on the paralyzed side of the face.

3. Dribbling of saliva from the angle of mouth on the side of paralysis.

4. Asymmetrical face.

5. Tears flowing down from the eye on the side of paralysis.
This happens because the patient is not able to completely close his eye, as well as because of infrequent blinking.

6. Loss of wrinkles over the forehead on the side of paralysis.

7. Earache
Ear pain may precede or accompany facial palsy.

8. Sensitivity to loud sounds may be present.

9. Diminished taste sensation

10. Recurrence

Bell’s palsy is recurrent in 12% of patients.

DIAGNOSIS

Diagnosis of Bell’s palsy is usually made on –

  • History of patient, and
  • Clinical examination of patient.
  • Doctor rules out all other causes that can cause of face paralysis.

TREATMENT of BELLS PALSY

1. REASSURANCE

The doctor needs to assure the patient that it is a common complaint and is routinely seen in OPDs (more commonly in winters), and NOT TO WORRY too much.

Also, medications will help in improving the condition of the patient.

2. PAINKILLERS like Aceclofenac, Ibuprofen, Paracetamol, or a combination, etc.

For the relief of ear pain (if present), only if prescribed by the examining doctor.

3. EYE CARE

As the eye is not closed completely, and also there is less blinking, there are chances that the eye on the paralyzed side of the face may dry up, leading to the formation of ulcer over the cornea (a medical condition called EXPOSURE KERATITIS).

Hence, good care of the eye should be taken.

The preventive measures to protect the eye include–

(a) Using Artificial tears (methylcellulose drops) every 1–2 hours and 4–5 times per day. eg. Refresh tears eye drops/gel®

(b) Eye ointment followed by patching or taping the eye. eg. Lacrigel ointment®

(c) Cover for the eye in the night with an EYE PATCH.

(d) When outside, protect the eye from wind, foreign bodies, and drying with PROTECTION GOGGLES/GLASSES

(e) When inside, the patient may use MOISTURE CHAMBERS/HUMIDIFIERS in the room.

(f) Temporary tarsorrhaphy may be needed in some cases.

4. PHYSIOTHERAPY OF FACIAL MUSCLES

Physiotherapy should be done by a certified Physiotherapist.

The patient should also do exercises taught by the physiotherapist for home sessions.

The facial muscles massage though does not influence recovery but may prevent the muscles of the face from going into permanent weakness.

5. MEDICAL TREATMENT

[A] Steroids:

Prednisolone, 1 mg/kg/day or 60-80 mg orally per day for 10 days depending upon whether the paralysis is incomplete or is recovering. Thereafter the dose is tapered in the following days.

NOT TO BE USED IN:

  • Pregnancy
  • Hypertension (High BP),
  • Peptic ulcer
  • Pulmonary tuberculosis
  • Glaucoma

[B] ANTIVIRALS

Valacyclovir or Acyclovir: Steroids are generally combined with antivirals.

[C] Other drugs:

Vasodilators, vitamins have been used by some with unsure benefits

[D] SURGICAL TREATMENT

Surgery done is called “FACIAL NERVE DECOMPRESSION.”

It relieves pressure on the nerve fibers and improves their blood circulation.

WHAT MIGHT HAPPEN IF SOMEONE GETS BELLS PALSY?

  • Majority of the patients (85–90%) recover fully in 6 months.

95 % patients of with incomplete Bell’s palsy recover completely.

The chances of complete recovery are better when clinical recovery begins within three weeks of onset.

  • Some of the patients (10–15%) do not recover completely.
  • There are chances that facial palsy may again occur.

PREVENTION OF BELLS PALSY

1. Patient should NOT EXPOSE himself to sudden temperature change.

2. Get up in the morning and firstly WEAR WARM CLOTHES & CAP as soon as you are out of bed.

3. Wash face with WARM WATER only.

4. Adequately COVER YOURSELF WITH WARM LAYERINGS while driving a 2 wheeler in winters.

5. AVOID STRESS

THANK YOU

REFERENCES

  1. ENT TEXT BOOKS
  2. Shemer A, Pras E, Lifshitz AE et al. Association of COVID-19 vaccine and facial nerve palsy: A case control study. JAMA Otolaryngol Head Neck Surg. 2021;147(8):739-43.
  3. Colella G, Orlandi M, Cirillo N. Bells palsy following COVID-19 vaccination. J Neurol 2021;21 : 1–3.

MEDICAL ADVICE DISCLAIMER

This blog including information, content, references, and opinions is for informational purposes only. The Author does not provide any medical advice on this platform.

Viewing, accessing, or reading this blog does not establish any doctor-patient relationship.

The information provided in this blog does not replace the services and opinions of a qualified medical professional who examines you and then prescribes medicines.

And if you have any questions of medical nature, please refer to your doctor or the qualified medical personnel for evaluation and management at a clinic/hospital near you.

The content provided in this blog represents the Author’s own interpretation of research articles.

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