The nerve that provides movement to each side of the face passes from the brain, through the ear and to the muscles on the side of the face. These muscles allow us to smile, wrinkle the nose, close the eye and raise the forehead.
Facial paralysis or weakness occurs as a result of varied diseases, many related to the ear. Such causes include Bell's palsy (a virus of the nerve), Lyme's Disease, fractures of the skull that go through the or tumors of the nerve or surrounding structures. As with hearing and balance disorders, advanced diagnostic techniques allow for proper, timely, diagnosis and treatment.
Bell's Palsy is the most common disorder causing paralysis of the face. Bell's palsy often begins with pain in or around the ear, followed hours or days later by weakness of the muscles of the face. Bell's Palsy is presumed to be due to a virus, although there is no specific test for the virus. Hearing and balance are usually normal. The treatment is oral corticosteroids (such as prednisone). Corticosteroids cut down on the inflammation of the nerve. The paralysis of Bell's Palsy usually begins to resolve within three weeks. In this case, the prognosis for complete recovery is excellent. Rarely, the recovery is delayed and incomplete with some residual facial weakness that never resolves.
Herpes Zoster Oticus (Ramsey Hunt Syndrome) is a Bell's Palsy caused by herpes zoster. This is characterized by blisters around the opening of the ear and is often associated with hearing loss and/or dizziness. In addition to corticosteroids, anti-herpes viral drugs are usually prescribed. The prognosis for Herpes Zoster Oticus is not as favorable as uncomplicated Bell's palsy. Many patients are left with some residual facial weakness.
All patients with Bell's Palsy should be tested for Lyme's Disease, which can also cause a facial weakness.