Bell’s palsy in the elderly
Bell’s palsy, also commonly known as facial paralysis. It is a type of neurological disorder, which is non–progressive in nature. Thought to be a disorder affecting pregnant woman and children. It affects the elderly population equally. The name Bell’s palsy is after Charles Bell, the famous anatomist. He was the one to explain the involvement of facial nerves in facial paralysis.
Understanding Bell’s palsy
Bell’s palsy occurs when the 7th cranial nerve gets damaged due to lack of blood supply. The condition usually strikes suddenly, which begins with weakness and gradually worsens within 48 hours of its onset. It affects one side of the face only. Elderly with Bell’s palsy, may experience fever, accompanied by a stiff neck and pain behind the ear before the paralytic attack. In severe cases, the effects may happen, on the side of the face, which becomes completely motionless, smooth and expressionless.
The onset of Bell’s palsy can indeed be a frightening experience. The sudden onset of symptoms can leave people wondering what they probably had a stroke. However, the symptoms of a stroke are much different than the symptoms of Bell’s palsy. How much ever frightening the condition may appear, but, it is by and large a harmless condition, that clears up on its own without a vigorous treatment regime. It is rarely a permanent condition. The paralysis should resolve within 3 months of the onset of symptoms. Bell’s palsy is also known by the following names – Antoni’s palsy, refrigeration palsy, idiopathic palsy, and facial nerve palsy.
The many functions of the facial nerve
Our facial nerve is the 7th cranial nerve. Which in Bell’s palsy each facial nerve run from the brain, beneath the ear and from there splits into several branches. The facial nerve is responsible for facial expressions, and also helps the muscles to close the eyes. It plays an important role in general sensation from the skin of the ear. The facial nerve is also responsible for the taste sensation from both the head as well as the soft palate of the tongue.
Causes of Bell’s palsy in the elderly
The exact cause behind the onset of Bell’s palsy continues to remain a mystery. However, in certain cases, low immunity and a viral attack such as herpes zoster and herpes simplex virus type 1, happen to play foul. In addition, other viruses such as cytomegalovirus, coxsackievirus, and virus that causes rubella, mumps, and influenza can also trigger facial palsy. The virus herpes zoster, responsible for causing chicken pox and shingles, thrives in the nerve roots of the humans. Whenever the immunity gets low, the virus seizes the chance and gets activated. However, the role of herpes zoster in the causation of Bell’s palsy still remains controversial. Doctors say that there are certain factors that can increase the chances of developing Bell’s palsy. These factors include:
- Having cold sores
- Suffering from influenza
- Upper respiratory tract infection
- Getting very upset for long periods of time
Symptoms of Bell’s palsy
The 7th cranial nerve plays a major role in controlling the muscles of the face. Involved in the detection of taste, stimulating the salivary glands for production of saliva and controlling the muscles that are involved in hearing. When affected this nerve can cause a variety of malfunctions. The head, eyes, lips, tongue and even the ears can get affected. The following are the symptoms of Bell’s palsy:
- The symptoms begin with mild weakness, which quickly progresses to total facial paralysis, within hours of its onset.
- There is continuous and uncontrolled loss of saliva from the mouth, a condition known as drooling
- Headache accompanied by dizziness
- Pain in the jaw and behind the ear
- Ringing sound in one or both the ears, coupled with an increased sensitivity to sound, especially on the affected side
- Pain in the affected side accompanied by increased sensitivity
- The taste ability diminishes, along with a decreased production of saliva, which ultimately affects the eating ability
- Smiling becomes difficult
- Speech gets affected
- Facial expressions also become a difficulty
- There is a drastic decrease in the production of tears
Treatment for Bell’s palsy
There are chances, that your elderly may fully recover without any treatment. However, taking certain medications as prescribed by the doctor, would fasten the recovery process. Here are certain medications used for treatment for Bell’s palsy.
These become the obvious choice and form the first line of treatment for Bell’s palsy. The reason being, that most cases of Bell’s palsy develop due to viral infections, due to which antiviral medications can come to rescue. Some of the antiviral medications can even stop the cold sore virus and the chicken pox virus from multiplying.
In many cases, steroid medications are also given along with antiviral drugs. The steroid course lasts for about 10 days, which works to a great extent in reducing the inflammation of the nerves. Prednisolone remains the choice of drug, and the chances of side effects are pretty rare. This is because side effects occur only when you take steroid medications for a longer duration. A short course of 10 days, will certainly not bring along any side effects.
In many cases, it may so happen that the individual is unable to close their eyes completely. This can damage their eyes, as the tear glands may also stop working appropriately, causing the eyes to become dry. Therefore, it becomes extremely necessary to protect the eyes, until there is complete recovery from Bell’s palsy. Use the following for eye protection:
- Covering the eyes with an eye pad or wearing goggles can help.
- Applying eye drops 2 – 3 times a day can help lubricate the eyes and protect it from drying.
- In many cases, doctors may suggest taping the upper and lower eyelids together, when the person is asleep. This method also prevents dryness and subsequent damage.
Complications of Bell’s palsy
Complications arise when the person doesn’t completely recover from Bell’s palsy. This is usually seen in individuals aged 60 years and above. When the symptoms of facial paralysis do not improve within a few weeks, then the following complications can arise:
- Asymmetrical smile
- An abnormal blink
- Damage to the cornea
- Food can get stuck in the cheek on the paralyzed side, a condition referred to as buccinator paralysis
- Muscles in the nostril can get frozen
- Impaired speech and taste
- Excessive perspiration
- Hyperacusis, a condition where the elderly perceives a normal sound as unusually loud
- Synkinesis, a condition characterized by an involuntary contraction of muscles. Like, for example, when you smile, there will be an involuntary contraction of the eye muscles on the affected side, causing it to close.
Recent research studies have pointed towards a link between Bell’s palsy and the increased risk of non–hemorrhagic stroke in the affected population. This link can associate to the fact that there is also an increased risk of stroke in patients with HSV–1 virus. This further explains a positive relationship of virus and the development off Bell’s palsy. Also, check out this post on strokes.