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Bell’s Palsy And Shingles

What Is The Prognosis

Bells Palsy (Facial Paralysis) | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

The prognosis for individuals with Bell’s palsy is generally very good. Clinical evidence of improvement occurs spontaneously within three weeks in 85 percent of cases, and most individuals eventually recover normal facial function. Some individuals may be left with mild residual facial weakness or show moderate to severe deficits. Bells palsy can have consequences from a previous injury or condition, such as involuntary mouth movements when trying to blink the eyes or incomplete recovery of facial muscle weakness resulting in trouble speaking or forming words .

Who Gets Bell’s Palsy

Anyone can develop Bell’s palsy and it affects men and women equally. It most commonly occurs between the ages of 15 and 60 years. About 1 in 60 people have a Bell’s palsy at some stage in their life. It is more common in people with diabetes and also in women who are pregnant.You’ll usually only get Bell’s palsy once, but it can sometimes come back. This is more likely if you have a family history of the condition.

How Long Bell’s Palsy Lasts

Most people make a full recovery within 9 months, but it can take longer. In a small number of cases, the facial weakness can be permanent.

Go back to see a GP if there are no signs of improvement after 3 weeks. Some cases might need to be treated with surgery.

Living with Bell’s palsy can make you feel depressed, stressed or anxious. Speak to a GP if it’s affecting your mental health.

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What Is The Recovery Time For Ramsay Hunt Syndrome

Ramsay Hunt syndrome recovery time depends on the severity of your facial paralysis. If you dont have much damage to your nerve and youre otherwise healthy, your symptoms may improve within a few weeks to a few months. However, it may take up to a year to achieve a full recovery. If the damage to your facial nerve is more severe, your chances of a full recovery are less likely.

Antiviral medications can help, but your chances of a full recovery are better if you start treatment within three days of symptoms appearing. Early diagnosis and prompt treatment with antiviral therapy seem to improve long-term outcomes. About 70% of people with Ramsay Hunt syndrome will return to complete or almost complete facial function. However, even with prompt treatment, some cases result in permanent facial paralysis or hearing loss.

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Recent developments in Bell

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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When To Call A Professional

If you have been diagnosed with Bell’s palsy, call your doctor immediately if your eye starts hurting or feels irritated. Call if your arms or legs feel weak, your vision changes, you get dizzy, have trouble swallowing, or get a headache that keeps getting worse. Contact your doctor promptly if any symptoms get worse.

Treatment Of Ramsay Hunt:

For those with Ramsay Hunt syndrome, , our preference is early, very high dose antiviral medication and high dose steroids, continuing both until at least the 21st day after disorder onset. While the published literature suggests that middle fossa facial nerve decompression is effective for Bells palsy, the question of adequacy of benefit from surgery has not been proven in Ramsay Hunt syndrome. Nevertheless, since nerve swelling seems to be the in-common issue that causes poor quality recovery, many think surgery is indicated for severe Ramsay Hunt facial paralysis.

In summary, Bells palsy can be a quite disfiguring disorder, but fortunately, for the vast majority, high quality recovery occurs within weeks. For those with delayed recovery, satisfactory function is highly likely but some degree of impairment, generally not severe, may remain. For those whose prognosis for a poor quality recovery seems high, surgery is a possibility. When facial paralysis features do not fit well with the classic features of Bells palsy or Ramsay Hunt syndrome, a careful evaluation for other causes is essential, as other very serious issues may exist for which other specific management is appropriate.

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How Does Ramsay Hunt Syndrome Differ From Bells Palsy

The symptoms of RHS can appear differently from person to person and can mimic another condition called Bells palsy. While both can cause facial paralysis, Bells palsy doesnt have a tell-tale rash inside the ear.

Bells palsy is a sudden or rapid onset of facial paralysis or weakness, which can develop over hours to a day or two, Dr. Coffman said. It tends to cause milder weakness of the face and improves faster than Ramsay Hunt.

In comparison to Bells palsy, RHS is more likely to cause permanent facial asymmetry, where the face doesnt look balanced.

The causes of facial weakness and paralysis with Bells palsy are unknown, but they could be viral or autoimmune-related.

What Are The Symptoms Of Bells Palsy In Children

Bell’s Palsy, Pathophysiology, Symptoms, Diagnosis and Treatment, Animation

Not all children react the same to this disorder. However, recorded symptoms include:

  • The child may complain of headache or pain behind or in front of the ear a few days prior to the onset of Bells palsy.
  • Swelling or drooping on one side of the face.
  • Drooling, excessive, or reduced production of saliva.
  • An inability to blink or completely close one eye.
  • The child has either excessive tears or marked dryness and inability to make tears in one eye.
  • Sounds seem louder than they really are.
  • The child is experiencing sensitivity to light.

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What Happens During The Diagnosis

After an examination, the otolaryngologist- head and neck surgeon may conduct a hearing test to determine if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism. Additional tests in the physicians office include a balance test and a tear test, to measure the eyes ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye cornea. In some circumstances, the physician may recommend a CT or MRI test to determine if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve. An additional diagnostic tool is the Electro neuronography , which stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.

National Institute of Neurological Disorders and StrokeBells Palsy Research

What Are Other Side Effects Of Ramsay Hunt Syndrome

Ramsay Hunt syndrome may also affect other nerves that are in close relationship to the facial nerve. This includes the 8th cranial nerve, which is important for hearing and balance. In addition to having facial paralysis and a rash on your face or ear, patients can also develop vertigo, dizziness, and hearing loss from Ramsay Hunt syndrome.

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Herpes Simplex Virus 1

of people under age 50 have HSV-1 worldwide.

HSV-1 is contagious. It can spread via contact with infected:

Although transmission can happen at any time, its more likely when cold sores are present.

Theres no cure for HSV-1. The virus remains in your body, lying dormant in nerve cells, some of which are associated with the facial nerve. The virus can occasionally reactivate, leading to cold sores.

Some researchers have detected HSV-1 in up to 50 percent of Bells palsy cases that theyve evaluated.

One small study found HSV-1 DNA present in the saliva of 11 out of 38 people with Bells palsy.

How Is Ramsay Hunt Syndrome Treated

Optimising treatment of Bellâs Palsy in primary care: the need for ...

Ramsay Hunt syndrome treatment may include various medications. Your healthcare provider may prescribe:

Natural treatment for Ramsay Hunt syndrome includes using a cold compress to reduce your pain. You may also consider wearing an eye patch. If youre unable to close your eye, you risk damaging your cornea due to irritation. You may also want to use artificial tears or eye lubricants to prevent your eye from drying out.

If you have complete facial paralysis, your healthcare provider may perform a surgical procedure. The surgery can help relieve the pressure on your facial nerves.

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What Sort Of Recovery Can Be Expected

  • If antiviral treatment is given within 72 hours of developing symptoms approximately 70% of people will experience a virtually full recovery.
  • If antiviral medication is not given within this time frame then the likelihood of making a full recovery reduces to 50%.
  • The more severe the damage, the longer it will take to recover, and the lower the chance that you will completely regain normal function.
  • If damage to the nerve is mild then recovery should take place within a few weeks.
  • Recovery follows a similar pattern to Bells palsy. However symptoms in RHS tend to be more severe than with Bells palsy.

The video below has tips how to manage your facial palsy while your face is floppy. Please note this is a series of 7 short videos in one.

If your eye still does not close properly after 2-3 weeks you should be referred to ophthalmology. If you are struggling to care for your eye with tape and eye drops then ask your GP to make an earlier referral.

If the paralysis shows no sign of improvement after one month you should be referred to a facial palsy specialist, this could be a plastic surgeon, neurologist or ENT consultant. Ideally you should be referred to a specialist facial therapist as well. Studies show that botulinum toxin injections can help with residual facial pain, spasms and involuntary facial movements.

When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix

Shingrix causes a strong response in your immune system, so it may produce short-term side effects. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days. You may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen. Contact your healthcare provider if the symptoms are not improving or if they are getting worse.

In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people might have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.

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What Other Syndromes Did James Ramsay Hunt Discover

James Ramsay Hunt described at least three syndromes. Ramsay Hunt syndrome type 2 is the best known of these conditions. Although they share Ramsay Hunts name, types 1 and 3 are unrelated to type 2.

Ramsay Hunt syndrome type 1 is a rare neurological disorder. It causes seizures, tremors, loss of bodily function and cognitive impairment. Ramsay Hunt cerebellar syndrome is another name for the condition.

Ramsay Hunt syndrome type 3 is a type of neuropathy in the palm section of your ulnar nerve. Hunt’s disease and artisan’s palsy are other names for the condition.

A note from Cleveland Clinic

Ramsay Hunt syndrome can occur as a complication of shingles. The condition can cause a painful rash, severe pain and facial paralysis. If you notice any of these symptoms, contact your healthcare provider right away. Youre more likely to make a full recovery with prompt diagnosis and treatment. You may also want to consider the shingles vaccine to prevent future outbreaks.

How Is Bells Palsydiagnosed

Is Bell’s palsy a risk with the COVID-19 vaccine?

Your healthcare provider can make a diagnosis based on symptoms. Other conditions, including stroke, sarcoidosis and Lyme disease, can also cause facial paralysis. To rule out those causes, you may have one or more of these tests:

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How Is Ramsay Hunt Syndrome Diagnosed

Your healthcare provider will perform a physical exam to diagnose Ramsay Hunt syndrome. Theyll ask you about your medical history and symptoms. Your provider will look for a rash and signs of weakness in your face.

Diagnosis can be difficult because the symptoms of the condition dont always develop at the same time. Therefore, your provider may request a laboratory test to confirm the diagnosis. They may collect a sample of your saliva, blood or fluid from a blister. A pathologist will examine the sample under a microscope, looking for the varicella-zoster virus.

It isnt necessary, but your provider may also request an imaging test called a magnetic resonance imaging scan. This test can give your provider proof that another condition or disorder isnt causing your symptoms.

You Cannot Prevent Bell’s Palsy

Because it’s probably caused by an infection, Bell’s palsy cannot usually be prevented. It may be linked to the herpes virus.

You’ll usually only get Bell’s palsy once, but it can sometimes come back. This is more likely if you have a family history of the condition.

Page last reviewed: 11 September 2020 Next review due: 11 September 2023

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Is It A Stroke Or Bells Palsy

Someone should seek immediate medical attention if, in addition to facial drooping, a person:

  • has difficulty speaking, for example, with slurred speech
  • cannot raise both arms and keep them raised
  • suddenly develops weakness on one side of the body

These may be signs of a stroke.

the brainstem to the face and tongue.

There is one on each side of the face, and they:

  • help control facial expressions, such as smiling and frowning
  • play a role in some jaw movements
  • control some muscles affecting the middle ear
  • stimulate glands that produce tears and saliva

Inflammation can cause compression on the nerve as it passes through the facial canal, a location near the temple where the nerve passes through the bony skull. This compression can affect the signals that travel from the brain to the facial muscles. This leads to the weakening or paralysis of facial muscles typical of Bells palsy.

Often, there is no clear reason why Bells palsy happens, but seventh facial nerve palsy is also linked to:

for children with Bells palsy.

Who Should Not Get Shingrix


You should not get Shingrix if you:

  • Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
  • Currently have shingles.
  • Currently are pregnant. Women who are pregnant should wait to get Shingrix.

If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.

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Treatments For Facial Paralysis:

If infection is the cause, then an antibiotic to fight bacteria or antiviral agents may be used. The prognosis for children with facial paralysis is generally very good. The extent of nerve damage determines the extent of recovery. With or without treatment, studies indicate that most pediatric patients with the disorder begin to get better within two weeks after the initial onset of symptoms and recover completely within three to six months. Adults may find residual symptoms remaining for an indefinite period of time.

What Are The Possible Side Effects Of Shingrix

Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects might affect your ability to do normal daily activities for 2 to 3 days.

Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. Some people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.

You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.

Guillain-Barré syndrome , a serious nervous system disorder, has been reported very rarely after Shingrix. There is also a very small increased risk of GBS after having shingles.

If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.

If you have any questions about side effects from Shingrix, talk with your doctor.

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