Bell's Palsy: Facial Nerve Paralysis Treatment in Sydney

Bell's palsy is a sudden weakness or paralysis of the muscles on one side of the face, caused by inflammation of the facial nerve (cranial nerve VII). It is the most common cause of acute facial paralysis, affecting approximately 1 in 5,000 people each year. At Central Sydney ENT, our FRACS-qualified surgeons are experts in facial nerve anatomy and provide specialist assessment, monitoring, and treatment for Bell's palsy across seven Sydney locations.

Symptoms of Bell's Palsy

Bell's palsy typically develops rapidly, with symptoms often reaching their peak within 48 to 72 hours. Symptoms include:

Sudden weakness or drooping on one side of the face
Inability to close the eye on the affected side
Drooping of the corner of the mouth, causing difficulty eating and drinking
Loss of the ability to raise the eyebrow or wrinkle the forehead on one side
Altered or reduced taste sensation on the front two-thirds of the tongue
Increased sensitivity to sound in the affected ear (hyperacusis)
Pain behind or around the ear on the affected side
Drooling and difficulty with facial expressions

Causes of Bell's Palsy

Bell's palsy occurs when the facial nerve becomes inflamed and swollen within the narrow fallopian canal of the temporal bone. The swelling compresses the nerve, disrupting its ability to transmit signals to the facial muscles.

The condition is believed to be triggered by viral reactivation, most commonly herpes simplex virus type 1 (HSV-1). Other viral triggers may include varicella-zoster virus (the cause of shingles), Epstein-Barr virus, and cytomegalovirus.

Risk factors include pregnancy (particularly the third trimester), diabetes, upper respiratory infections, and a family history of Bell's palsy. It can affect anyone at any age but is most common between the ages of 15 and 60.

Diagnosis

Bell's palsy is primarily a clinical diagnosis based on the pattern of facial weakness and the speed of onset. Your ENT specialist will conduct a thorough assessment including:

Facial nerve grading: Using the House-Brackmann scale to document the severity of facial weakness, which guides treatment decisions and allows monitoring of recovery.

Otoscopy and hearing assessment: To exclude ear conditions that may cause facial nerve involvement, such as cholesteatoma or middle ear infections.

Electroneurography (ENoG): An electrical test measuring facial nerve function, useful in predicting recovery in severe cases when performed within two weeks of onset.

Imaging (MRI): May be ordered if recovery does not follow the expected pattern, or if there are features suggesting a cause other than Bell's palsy, such as a tumour or infection.

Treatment Options

Corticosteroids: A course of oral prednisolone started within 72 hours of symptom onset is the cornerstone of treatment. Steroids reduce inflammation and swelling around the facial nerve, significantly improving the chance of full recovery.

Antiviral medication: Valaciclovir or aciclovir may be prescribed alongside steroids in moderate to severe cases, particularly when a viral cause is suspected.

Eye protection: If the eye cannot close fully, lubricating eye drops during the day and ointment with taping at night are essential to prevent corneal damage. Your specialist may refer you to an ophthalmologist if eye care is a significant concern.

Physiotherapy: Facial exercises and physiotherapy may be recommended during the recovery phase to promote muscle re-education and prevent synkinesis (involuntary facial movements).

Surgical intervention: Facial nerve decompression surgery may be considered in severe cases with complete paralysis and poor electrical nerve testing results. This is a decision made by your ENT surgeon based on specialist investigation findings.

When to See an ENT Specialist

If you develop sudden facial weakness, seek medical attention urgently to rule out stroke. Once stroke has been excluded, your GP or emergency doctor should refer you to an ENT specialist if:

You have complete facial paralysis (no movement at all on the affected side)
Symptoms do not begin improving within three weeks
There are atypical features such as bilateral weakness, hearing loss, or other cranial nerve involvement
You have had recurrent episodes of facial weakness
Eye closure is significantly compromised

Our Specialists

Bell's palsy and facial nerve conditions are managed by our team of six FRACS-qualified surgeons at Central Sydney ENT. Our otology specialist Dr Philip Yeung has particular expertise in facial nerve disorders. Assessments are available at our Burwood main practice and satellite locations in Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill, and Miranda.

Related conditions: Vertigo & Dizziness • Perforated Eardrum • Neck Lumps

Related procedures: Ear Surgery & Hearing • Head & Neck Surgery

Frequently Asked Questions

What causes Bell's palsy? +

Bell's palsy is caused by inflammation and swelling of the facial nerve as it passes through a narrow bony canal in the skull. It is believed to be triggered by viral reactivation, most commonly herpes simplex virus (HSV-1), though the exact cause is not always identified.

How long does Bell's palsy take to recover? +

Most people with Bell's palsy begin to improve within two to three weeks, with the majority achieving full or near-full recovery within three to six months. Approximately 15% of patients may have some residual facial weakness.

Should I go to hospital for Bell's palsy? +

If you develop sudden facial weakness, you should seek medical attention urgently to rule out a stroke, which can present similarly. Once a stroke is excluded, your GP or emergency doctor will start treatment and refer you to an ENT specialist for ongoing management.

What treatment is given for Bell's palsy? +

Treatment typically includes a course of oral corticosteroids (prednisolone) started within 72 hours of onset, antiviral medication in some cases, eye protection with lubricating drops and tape, and referral for specialist assessment if recovery is not progressing.

Can an ENT specialist help with Bell's palsy? +

Yes. ENT surgeons are specialists in facial nerve anatomy and function. They can perform detailed facial nerve testing, monitor recovery progress, investigate atypical presentations, and provide surgical intervention such as facial nerve decompression in severe cases.