Last reviewed: 29 Oct 2020
Last updated: 20 Nov 2019

Summary

Definition

History and exam

Key diagnostic factors

  • single episode
  • unilateral
  • absence of constitutional symptoms
  • involvement of all nerve branches
  • keratoconjunctivitis sicca
  • pain
  • synkinesis

Other diagnostic factors

  • presence of risk factors
  • any age
  • hyperacusis
  • dysgeusia

Risk factors

  • intranasal influenza vaccination
  • pregnancy
  • upper respiratory tract infection
  • black or Hispanic ancestry
  • arid/cold climate
  • hypertension
  • family history of Bell's palsy
  • diabetes

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • electroneuronography (ENoG) (evoked electromyography - eEMG)
  • needle electromyography (EMG)
  • serology for Borrelia burgdorferi
More 1st investigations to order

Investigations to consider

  • pure-tone audiometry
  • tympanometry and stapedius reflex
  • MRI (gadolinium-enhanced fine-cut of facial nerve course)
  • CT (fine-cut, non-enhanced)
More investigations to consider

Treatment algorithm

Contributors

Professor of Otology and Laryngology

Director, Division of Facial Plastic and Reconstructive Surgery and Director, Facial Nerve Center

President, Sir Charles Bell Society

Massachusetts Eye and Ear Infirmary and Harvard Medical School

Boston

MA

Disclosures

TH declares that she has no competing interests.

Fellow

Division of Facial Plastic and Reconstructive Surgery

Massachusetts Eye and Ear Infirmary

Boston

MA

Disclosures

NJ holds a patent on the methods and systems for functional electrical stimulation of the paralysed face (WO2017124019A1).

Dr Tessa Hadlock and Dr Nathan Jowett would like to gratefully acknowledge Dr Vishnu Madhok, Dr Iain Swan, Dr Pauline Lockhart, Dr Michael Norbury, and Dr John Gail Neely, previous contributors to this topic. VM, IS, PL, MN, and JGN declare that they have no competing interests.

Peer reviewersVIEW ALL

Consultant Neurologist

Barts Health NHS Trust

London

UK

Disclosures

GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences and symposia with the following companies - GSK, Astra Zeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.

Major

US Air Force

MC Program Director

Department of Neurology

MMCN

Wilford Hall Medical Center

Lackland Air Force Base

TX

Disclosures

PG declares that he has no competing interests.

Consultant in ENT/Thyroid Surgery

Arrowe Park Hospital

Upton

Wirral

UK

Disclosures

VS declares that he has no competing interests.

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