The following document was written by Mr Vik Veer MBBS(lond) MRCS(eng) DoHNS(eng) in Dec 2007. You may use the information here for personal use but if you intend to publish or present it, you must clearly credit the author and
This site is not intended to be used by people who are not medically trained. Anyone using this site does so at their own risk and he/she assumes any and all liability. ALWAYS ASK YOUR SENIOR IF YOU ARE UNSURE ABOUT A PROCEDURE. NEVER CONDUCT A PROCEDURE YOU ARE UNSURE ABOUT.


This is lower motor facial nerve palsy of unknown origin and should be regarded as a diagnosis of exclusion.

So to exclude other causes a good history and examination is required.

Bells palsy typically presents with:

On examination you should grade the facial nerve palsy using the House and Brackmann grading system You should, as a minimal, examine the course of the extra-temporal facial nerve (as parotid tumours for example can give you facial palsies – although they tend to present as partial nerve palsies.)

You should examine the ear (please see the ear examination topic for this). Look out for vesicles in the conchal bowl as this would indicate Ramsay-Hunt syndrome (zoster infection of the geniculate ganglion). Also disease of the middle ear can also affect the facial nerve so things like cholesteatoma (see link to may present with facial nerve palsy.

Bell’s palsy can affect any age group, although the elderly more slightly more affected.
Those with diabetes are more likely to get bell’s palsy
Those who are pregnant – particularly in the 3th trimester – and particularly those who have pre- eclampsia


This is quite controversial but a safe formula would be to prescribe:

*New England Journal of Medicine. 2007 Oct 18;357(16):1598-607 'Early treatment with prednisolone or acyclovir in Bell's palsy' - the evidence from this well designed trial suggests that in patients who present within 72 hours of symptoms, prednisolone should be given but not aciclovir. More research is required to assess the effectiveness of valaciclovir in bells palsy.

**Hato N, Yamada H, Kohno H, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007;28:408-13.


Most patients will eventually achieve full recovery (90%+)
About 80-85% have full function after 3 months.
About 85% have some improvement within 3 weeks.
Those who have a incomplete facial palsy (House-Brackmann of 2-5) have a better chance of full and quick recovery.
The younger you are the quicker the recovery.
The more symptoms you have initially (post auricular pain, metallic taste etc.) and the more risk factors you have (diabetic, pregnant etc) the slower and worse the prognosis.

Further Reading

eMedicine - Bell's Palsy : Article by Craig H Zalvan, MD

eMedicine - Bell Palsy : Article by Michael Lambert, MD,

Wikipedia - Facial Nerve


The authors of this document have attempted to provide information that is medically sound and up-to-date. The authors nor cannot take any reponsibility for the accuracy or completeness of this article. The reader should confirm the statements made in this website before using the information outside this website.