facial nerve
Bell's palsy is a partial facial paralysis caused by inflammation of the facial nerve. Gray's Anatomy
peter hess, a reporter with bell's palsy

Typical symptoms

I took this selfie less than 24 hours after my symptoms began. As you can see, I can only squint one of my eyes and wrinkle one side of my forehead.

I can’t close my right eye all the way. I’ve gotten face wash in it nearly every day for the past two weeks. I’ve also had a persistent metallic taste in my mouth, an inability to drink without dribbling, and a strange pain behind my ear. It all began on the first Sunday night of October, when I came down with Bell’s palsy.

Earlier that night, while eating dinner with a friend, I was swishing water in my mouth trying to dislodge an errant fragment of roast pork from my teeth, and I splurted water down my shirt. I thought nothing of it, as I’m often a messy eater. But later that night, while rinsing my mouth after brushing my teeth, the same thing happened. It felt like a cheap gag from a comedy in which a character has just had dental surgery and is still experiencing the after-effects of novocaine. But I was not laughing. I was afraid. I looked in the mirror and opened my mouth wide, but the right side didn’t open. I wrinkled my forehead, but the right side remained smooth. I scrunched up my eyes, but my right eye wouldn’t close. With each motion—or lack thereof—my fear increased. The right side of my face was paralyzed.

The first thing I thought was that I’d experienced a stroke, a sudden loss of blood flow to the brain that can result in rapid cell death. Strangely enough, I had just read a Leslie Jamison essay the night before, in which she described her brother’s experience with Bell’s palsy. Before then, I’d never heard of the condition. Fortunately, a quick Internet search reassured me that this was more likely than a stroke, but I was still too worried to sleep.

A doctor’s appointment the next day confirmed that I had Bell’s palsy, a condition caused by inflammation of the nerve that controls my facial muscles. The pain I felt behind my ear was the inflamed nerve pressing against the narrow bone tunnel through which it passes. This pressure damages the nerve and keeps it from carrying motor signals from my brain to my face. It’s a strange feeling, to be telling my body to move but my body not responding. This bizarre condition, coupled with my reporter’s curiosity, filled me with more questions than doctors have answers:

What causes the inflammation?

Nobody knows for sure. Some studies suggest that the herpes simplex virus—whose two variants cause cold sores or genital herpes—is to blame, but many doctors warn that there is not enough evidence to say this for sure. Other possible causes include a brain tumor, the virus that causes chickenpox and shingles, mononucleosis, and Lyme disease, just to name a few. In short, while the condition is easy to identify, the underlying causes are not.

facial nerve

Facial nerve

Bell’s palsy is a partial facial paralysis caused by inflammation of the facial nerve.

What can I do?

Not much. But there is one treatment that doctors seem to agree on. Lennart Belok, my neurologist at New York University’s Student Health Center, says it involves reducing nerve inflammation. “Steroids are used because there is probably some swelling of the facial nerve in its bony canal,” he tells me. He also tells me to use a gentle lubricating eye drop, since my lid doesn’t shut all the way. This will help prevent damage to my cornea from over-drying.

So I started taking prednisone, 60mg a day. This is not an easy medication for me to take, as it makes me feel like I’ve had way too much caffeine. But with Bell’s palsy, neurologists seem to agree that it’s important to treat it quickly with steroids such as prednisone. Because I’ve had the herpes virus in the form of cold sores ever since I was a kid, Belok prescribed the antiviral valacyclovir, even though it’s not clear whether it helps. I’ll take whatever odds I can get, though.

The treatment guidelines set forth by the American Academy of Neurology conclude that, “For patients with new-onset Bell’s palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function.” So I wondered, what could it look like to not recover facial nerve function?

How long does it take to get better?

It varies. For 85 percent of patients, improvement begins within three weeks of the outbreak. For the rest, it can take three to six months. “Fortunately,” Belok tells me, “prognosis is usually excellent in young people.” At age 29, I think that label probably still applies to me.

Will it get better?

Probably, but there is the possibility that I could be left with permanent damage. Because the inflamed facial nerve is squeezed against the inside of its bone passageway, the myelin sheath that protects the nerve can be frayed like a wire whose cover has been stripped away. When the inflammation subsides and my condition improves, it’s possible that the damaged nerve bundle could rewire itself incorrectly, crossing paths and resulting in a condition known as synkinesis. This could mean that, even once my facial paralysis has gone away, my eye might water whenever I salivate, or the corner of my mouth might twitch whenever I blink.

Fortunately, 71 percent of patients recover normal function eventually, and I’m cautiously optimistic that I’ll be among this number. It’s been over two weeks since my symptoms began, and I’m finally able to twitch my right cheek. I still can’t blink correctly, and my lip gets in the way of my teeth when I try to eat a burger, but hopefully I’ll be back to normal soon.

What can be done if it doesn’t get better?

For the unlucky 29 percent of Bell’s palsy patients who don’t recover normal facial function, there are two therapies. First, for synkinesis that involves involuntary muscle movement, doctors can use botox injections to relax the overactive muscles. This is not a cure, but it treats the symptoms. Second, for patients who experience persistent muscle weakness, physical therapy can help re-educate the muscles to eventually gain back some lost function.

Based on my recent cheek twitches, I’m hopeful that I’ll regain full function within the typical time range. For better or for worse, I might be healed too soon to dress as Harvey Dent for Halloween.