Aging Begins at 30

The Lopsided Smile

"You don't look well this morning," I said to my brother-in-law Doug.
"Yes, I've had a pain behind my left ear for two days and now my face is twisted."
"Smile for me, please."

The right side of his face smiled but his left face was sad and droopy. He drooled saliva and I could see uncontrolled tears from his left eye.

Doug had Bell's palsy.

Dr. Charles Bell described Bell's palsy in 1821. No, he's not the Dr. Bell after whom Sir Arthur Conan Doyle modeled Sherlock Holmes and not even related, although they both came from Edinburgh.

Most of us have had cold sores caused by the herpes simplex virus. Bell's palsy is probably a complication of this virus infecting the facial nerve which supplies all of the muscles of the face except the chewing ones. Doug's symptoms might also have been caused by herpes zoster or shingles virus which can also affect the facial nerve. The facial nerve passes through a narrow boney canal at the side of the head, above and behind the cheekbone arch. Any swelling puts damaging pressure on it.

"Can you taste normally?"
"Yes, but only on the right."
"How about your hearing?"
"You know it almost hurts on the left and I hear much better than I usually do."

It wasn't Doug's imagination. Bells' palsy stimulates the ear and temporarily improves hearing.

"What will I do about it?" he asked.
"The main difficulty is to rule out more serious problems such as stroke or brain tumor so you'll have you see a neurologist. Eight out of ten chances it will all be gone in 2-4 weeks. But you'll need to protect your eye with artificial tears in the daytime and ointment at night. Your pharmacist can supply these without prescription. Maybe we'll have to tape your eyes shut at night. Some people like to stimulate the nerve electrically. I doubt it does any good."
"Didn't I read that surgeons could decompress the nerve in that canal."
"Yes they can, but it is not done unless no recovery is seen after 3 to 5 weeks."

The Mayo Clinic published a paper on Bell's palsy based on a long study of the people of Olmsted County. Their study was the first clinical study of Bell's palsy in a circumscribed population. It affected 24/100,000 of the population, there was no seasonal variation, and no clustering of cases. It wasn't preferentially related to diabetes, pregnancy, or hypertension. They did find more residual damage in older people and in those with longer attacks or tearing in the acute phase. In all, 14% had residual damage observable by friends and colleagues.

Getting Bell's palsy can be frightening but it is very seldom a problem for long. It's still important to see a doctor because you may have something else that is more serious and would benefit from immediate treatment.

By the way, Doug made a complete recovery.

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