Bell's palsy - Treating Bell's palsy

Prednisolone is recommended as the most effective treatment for Bell’s palsy, and it should be started within 72 hours of the symptoms appearing.

Most people recover fully from Bell's palsy within nine months, but it's important to maintain good eye care during this time.

Antiviral medications are not recommended as a treatment for Bell's palsy.

Prednisolone

Prednisolone is a corticosteroid which works by helping to reduce inflammation (swelling), helping to speed up your recovery.

People with Bell's palsy are usually advised to take prednisolone tablets twice a day for 10 days.

Possible side effects of prednisolone include:

• nausea (feeling sick)
• headache
• increased sweating
• indigestion
• increased appetite
• difficulty sleeping
• oral thrush
• dizziness

These side effects should improve within a few days as your body begins to get used to the medication.

Some people also experience mood changes, such as anxiety or depression, after taking steroids for a short period of time. You should visit your GP immediately if you experience mood changes, or if you have other side effects that are particularly troublesome.

Read more about the side effects of corticosteroids.

Speak to your GP before taking prednisolone if you are pregnant or breastfeeding.

Eye care

Tears play an important role in protecting your eyes and keeping them free of the dirt and bacteria that can cause eye infections.

If you have Bell’s palsy, you might find it difficult to close your eye, which can cause your tears to evaporate and leave your eye vulnerable to infection. So it's very important to keep your eye lubricated.

Your GP may prescribe eye drops that contain 'artificial tears' for daytime use, plus an ointment that you should use at night. If you're unable to shut your eye at night time, your GP will give you some surgical tape to close your eye.

If your eye symptoms get worse, you should ask your GP to refer you to the facial palsy clinic or ophthalmology department of your local hospital for assessment. If ointments and taping are not effective you may benefit from surgery to help protect your eye.

Further treatment

Most people with Bell's palsy will make a full recovery within nine months. However, if you have not recovered by this time, there is a risk of more extensive nerve damage and further treatment may be needed.

Physiotherapy

Physiotherapy may be recommended. Your physiotherapist will teach you a series of facial exercises that will strengthen the muscles in your face to improve their co-ordination and range of movement.

Physiotherapy has been successful in a number of Bell's palsy cases, although it may not be suitable or effective for everyone.

Plastic surgery

Plastic surgery is another possible option. Plastic surgeons work as part of a team of facial palsy specialists to help manage your facial weakness. Surgery may not be able to restore nerve function, but may be able to protect your eye, improve your function and improve the appearance of your face.

Eye procedures include surgery to help you close your upper eyelid or improve the position of your lower eyelid. A brow lift can improve your vision and facial appearance.

A number of procedures can improve the position of your mouth and help with speech, eating and drinking and facial symmetry. Some can restore a smile, including cross-facial nerve grafts, nerve transfers and muscle and tendon transfers.

Botulinum toxin injections

Botulinum toxin (Botox) injections can be used to treat either the affected or the unaffected side of the face in some people with long-term Bell's palsy.

Botox may be injected into the affected side of the face to relax any facial muscles that have become tight, or to reduce any unwanted muscle movements.

If the muscles in the unaffected side have become overactive or dominant, Botox may be injected into this side of the face to reduce muscle activity and balance the movement of the face.

Some of the long-term complications of Bell’s palsy can also be treated using Botox injections. These include:

• tears when eating
• eye-mouth synkinesias – where the facial nerve grows back in a different way, which can lead to a winking eye when eating, smiling or laughing

Read more about the complications of Bell’s palsy.

The Botox injections can help ease any discomfort experienced while eating and can also help to improve the overall appearance of the face. The injections need to be repeated every four months.

Other treatments

Research has suggested that facial exercises, relaxation techniques and acupuncture may help speed up the recovery of Bell’s palsy and restore facial nerve function.