Part 1. Public & Medical Recognition of the symptoms of Facial Palsy

The theme of this year’s Facial Palsy Awareness week is “Recognising Facial Palsy”.

Facial palsy is not as uncommon as is generally believed. One in every 3000 people are affected by Facial Palsy, yet many have difficulty recognising the signs and symptoms of Facial Palsy.

• Preceding the facial weakness there may be tingling or numbness in the cheek/lips/mouth.

• Preceding the facial weakness there may be a non-specific headache, fever and/or fatigue for a few days.

• Facial Palsy usually affects only one side of your face. It does not cause any weakness in your arms or legs.

If you are experiencing weakness in your face and in your limbs, and/or have issues with memory/speech, and/or have risk factors for stroke (such as high BP, are overweight, older, etc), seek immediate medical attention as these symptoms may indicate a stroke.

• A complete Facial Palsy affects the brow/eye; the cheek and the mouth on one side of your face.

• An inability to blink or close your eye on the affected side of your face. The eye may be wider and feel gritty, dry and/or tear excessively.

• A sensitivity to noise.

• Due to the weakness of the muscles around the mouth your speech might be affected, your ability to eat, you may drool when drinking, you might have changes to your taste and have difficulty with tasks like brushing your teeth.

• You may have Pain in your ear/side of face and/or the sensation in your face might be altered.

• Most commonly the onset is rapid, developing over a few hours to a few days. This depends on the cause of Facial Palsy, however.

• **In some cases (RHS) there may be a rash present.

If you develop symptoms of Facial Palsy, you should seek medical advice within 72 hours of onset either with the GP or A+E, as research indicates that this is the optimum period of time in which the most common causes of Facial Palsy (Bell’s Palsy and Ramsay Hunt Syndrome) will successfully respond to treatment.

It is important that your medical practitioner recognises the many causes of Facial Palsy

Not all Facial Palsy is due to Bell’s Palsy.

Although Bell’s Palsy is the most common type/cause of Facial Palsy, there are in fact over 50 other known causes. Establishing a correct diagnosis is vital in ensuring the best outcome is achieved.

To distinguish between the different causes/types of Facial Palsy, it is important for your practitioner to gain information from questions such as “Did your symptoms come on suddenly over the last few days or has it been coming and going for a few weeks? Do you have ear pain? Do you have any issues with your balance? Do you have any other medical issues?

 In addition, performing a thorough physical exam is important. You should be asked to complete several facial expressions to assess if you have complete or partial facial paralysis. Palpation of your glands and behind your ears and an otoscope exam of your ears and mouth for vesicles, should routinely form part of your exam.

Depending on the results of both questioning and the physical exam, your practitioner may need to refer you for further exams or imaging.

1.   Viral Infection – Bell’s Palsy and Ramsay Hunt Syndrome are caused by viral infections, but of different types. RHS is caused by the virus that causes chicken pox or shingles.

2. Bacterial Infection – Lymes disease or Ear infection

3. Following surgery to the parotid gland or to remove an acoustic neuroma

4. Trauma – either from a cut to the face or fracture to the skull

5. Tumours – benign tumours called acoustic neuroma can occur on a nerve very close to your facial nerve resulting in pressure on the facial nerve. Very rarely malignant tumours can cause Facial Palsy.

6. Congenital – some children are born with Facial Palsy

7. Neurological conditions such as Guillian Barre Syndrome

8. Stroke

The survey below highlights the importance of differentiating between Bell’s Palsy (the most common type of Facial Palsy, and RHS (2nd most common type of Facial Palsy).

The difference in the diagnosis of Bell’s Palsy and RHS is extremely important as there is a much higher significance for the use of antiviral medication in conjunction with corticosteroids in RHS.

The symptoms associated with RHS are generally more severe than in Bell’s Palsy and can be slower to recover. In the less severe cases of Bell’s Palsy, symptoms may start to improve within a few weeks. In the more severe RHS, symptoms may not start to improve for many months following onset of the Facial Palsy.

The prognosis is generally poorer in cases of RHS than in Bell’s Palsy also. In cases of Bell’s Palsy, over 70-80% of people experience a full recovery. In RHS somewhere between 50-70% of people experience a complete recovery.

Although Bell’s and RHS have a similar onset, usually quite rapid, there are some additional symptoms of RHS that can distinguish the two. These include:

• Dizziness/vertigo; balance issues
• Severe pain
• Hearing loss
• Rash

** A rash is not always present at the time of onset of facial weakness. It also may be present on the scalp or in the mouth, rather than in the ear.

If you are experiencing any of the additional symptoms of Facial Palsy, it is worth asking your medical practitioner to thoroughly examine your ear/nose/throat/scalp for signs of a rash.

Generally, it is safer to assume that you might have RHS rather than Bell’s and treat with both corticosteroids and antivirals, as it can be difficult to distinguish in that critical 72 hour (about 3 days) window for treatment with medication.

This is just one example of one different diagnosis to Bell’s Palsy.

It is important that your medical practitioner holds high suspicion for differing causes of Facial Palsy, depending on your presentation.