Facial Paralysis — act quickly, recover well.

Overview

Bell's palsy, the most common cause, is an idiopathic inflammation of the facial nerve. It is not a stroke (though it can feel like one), and it typically resolves over several weeks to months. Steroids started early shorten recovery; antivirals are sometimes added.

Other causes — Ramsay Hunt syndrome (shingles affecting the nerve), middle-ear or parotid infections, trauma, and rare tumours — need targeted treatment. A clinical examination and, when indicated, imaging or audiometry sort them out.

Symptoms

• Sudden one-sided drooping of the face
• Inability to close the eye on the affected side
• A crooked smile and trouble holding food or saliva
• Pain behind or around the ear (especially in Ramsay Hunt)
• Reduced taste or sensitivity to loud sounds on the affected side

Common Causes

• Bell's palsy — the commonest, presumed viral inflammation
• Ramsay Hunt syndrome — shingles of the facial nerve
• Middle-ear infections involving the nerve
• Trauma or surgery near the parotid gland
• Rarely, tumours of the parotid or cerebellopontine angle

Treatment Options

• High-dose oral steroids, ideally started within 72 hours
• Antiviral medication in Ramsay Hunt and selected Bell's cases
• Strict eye protection — lubricant drops by day, taping the eye at night
• Facial physiotherapy through the recovery period
• Surgery for traumatic, tumour-related, or non-recovering cases

When to See an ENT

Any sudden facial weakness needs prompt assessment — within 24 hours if possible — to rule out stroke and to start steroids before the 72-hour window closes. Pain or a rash near the ear with facial weakness suggests Ramsay Hunt and is a same-day issue.