Published: 2022-02-25

Incidence and management of Bell’s palsy in peripheral facial paralysis cases

Sucheta Gupta, Vinod Gupta


Background: The underlying pathophysiology observed in cases of Bell’s palsy is vascular distension, inflammation and oedema with ischaemia of the facial nerve. Various causes have been proposed including viral, inflammatory, autoimmune and vascular. The aim of this study was to evaluate the incidence and clinical presentation of Bell’s palsy among North Indian patients.

Methods: A randomized prospective observational study was carried out in the department of otorhinolaryngology and head neck surgery, CHC, Chenani, Udhampur, on 60 patients, who presented with facial nerve palsy over a period of one year from August 2019 to July 2020. Patients were evaluated using the House-Brackman scale (HBS) and studied in relation to incidence, associated symptoms, percentage of recovery and effect of treatment on the rate of recurrence.

Results: Of the 60 patients of facial nerve palsy, 44 patients were diagnosed of Bell’s palsy. 16 (37.5%) patients were grade II, 9 (14.6%) were grade III, 11 (31.3%) were grade IV, 7 (14.6%) were grade V and 1 (2.0%) patient was grade VI at onset. 21 (47.73%) patients had postauricular pain and 7 (15.90%) had hearing changes (phonophobia) during the attack. 35 (79.54%) patients recovered normal, while 9 (20.46%) patients did not return to normal life till the end of the follow up period. Out of the total 84.09% patients recovered, recurrence was also very low at 4.54%.

Conclusions: A significant number of patients recovered fully from the condition; however, eye protection remains crucial in preventing long-term eye complications.


Antiviral drugs, Bell's palsy, Corticosteroids

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DeDiego-Sastre JI, Prim-Espada MP, Fernández GF. The epidemiology of Bell’s palsy. Rev Neurol. 2005;41(5):287-90.

Hauser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota. Mayo Clin Proc. 1971;46(4):258-64.

Adour KK, Byl FM, Hilsinger RL, Kahn ZM, Sheldon MI. The true nature of Bell's palsy: Analysis of 1,000 consecutive patients. Laryngoscope. 1978;88(5):787-801.

Resendel L. Peripheral facial paralysis in history. Arq Neuro-Psiquiatr. 2008;66(3).

Bird TD. Niclaus A. Friedreich’s descriptions of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psych.1979;42(1):56-8.

Linder T, Bossart W, Bodmer D. Bell’s palsy and Herpes simplex virus: fact or mystery? Otol Neurotol. 2005;26(1):109-13.

Seok JI, Lee DK, Kim KJ. The usefulness of clinical findings in localising lesions in Bell’s palsy: comparison with MRI. J Neurol Neurosurg Psychiatry. 2008;79(4):418-20.

Grogan PM, Gronseth GS. Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence- based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2001;56(7):830-6.

Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto Laryngologica. 2002;122(7):4-30.

Katusic SK, Beard CM, Wiederholt WC. Incidence, clinical features and prognosis in Bell’s palsy. Ann Neurol.1986;20(5):622-7.

House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-7.

Satoh Y, Kanzaki J, Yoshihara S. A comparison and conversion table of ‘the House-Brackmann facial nerve grading system’ and ‘the Yanagihara grading system’. Auris Nasus Larynx. 2000;27:207-12.

Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med. 2007;357(16):1598-607.

Urban PP, Forst T, Lenfers M, Koehler J, Connemann BJ, Beyer J. Incidence of subclinical trigeminal and facial nerve involvement in diabetes mellitus. Electromyogr Clin Neurophysiol. 1999;39(5):267-72.

Pecket P, Schattner A. Concurrent Bell’s palsy and diabetes mellitus: a diabetic mononeuropathy? J Neurol Neurosurg Psychiatry. 1982;45(7):652-5.

Almeida JR, AlKhabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta- analysis. JAMA. 2009;302(9):985-93.

Engstrom M, Jonsson L, Grindlund M, Stalburg E. House-Brackman and Yanagihara grading scores in relation to electroneurographic results in the time course of Bell’s palsy. Acta Oto Lryngologica. 1998;118(6):783-9.

Gordana D, Stojanka D. Early prognostic value of electrophysiological tests in Bell’s palsy, estimating the du- ration of clinical recovery. Med Biol. 2005;12(1):47-54.

Allen D, Dunn L. Aciclovir or valaciclovir for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2004;3:001869.

Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2011;12:006283.