Bell’s Palsy (7^th nerve)

• Presentation
  • Ipsilayteral tear/taste, ear pain
  • LMN facial paralysis
• Epid
  • 69% unilateral
  • 71% normal by 3-6 months
  • 7.1% recur (ipsi or contra)
    • 15% of these have 2 recrurrences
• If bad synkinesis, facial contracture, gustatory tearing
• Imaging
  • Indications: ipsilateral hearing loss, vestibular symptoms, otorhea, paralysis>6mos, other CN, pain persists > onset
• DDx:

DM2
FHx (is a RF)
Sarcoid
Temporal bone #
Skull osteomyelitis
Lyme
EBV
Amyloidosis
Tumor -MRI/GAD – brain, Internal auditory canal, parotid; CT of temporal bone
Sjogrens – associated facial palsy
Cryptococcal meningitis
TB meningitis
Syphilis
Leprosy
Ramsey Hunt Syndrome -zoster of geniculate ganglion	Severe otalgia – vesicles Can affect CN 5,9,10,11,12
HIV	Seroconversion Asceptic meningitis Brainstem mass
Peds – mobius syndrome	Congenital

Management:

• Acyclovir (not much evidence)
• Prednisone
• Eye drops/patch – avoid corneal ulcer

EMG – prognosis – poor if low motor amplitude