Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Bell's palsy - Management
How can I confirm a diagnosis of Bell's palsy?

  • Typically:
    • Maximum facial weakness develops within 2 days.
    • Earache, pain behind the ear, aural fullness, or facial pain may precede the palsy.
    • Severe pain might indicate Ramsay Hunt syndrome. This is caused by herpes zoster and is associated with a painful rash and herpetic vesicles.
  • Confirm that the paralysis is caused by a unilateral, lower motor neuron lesion.
    • The muscles controlling facial expression are affected on one side of the face only. This may result in drooping of the brow and corner of the mouth, weakness of the frontalis (forehead muscle), or inability to close the eye.
    • In an upper motor neuron lesion, wrinkling of the brow, eye closure, and blinking are not affected.
  • Loss of taste of the anterior two-thirds of the tongue (on the same side as the facial weakness) may occur.
  • Only the facial nerve is affected.
  • Exclude serious underlying pathology:
    • Evidence of asymmetry of the oropharynx and ipsilateral tonsil might indicate a parotid tumour.
    • Hearing impairment, discharge, bleeding, dizziness, vertigo, disorder of balance, pain, headaches, or tinnitus are symptomatic of cholesteatoma.
    • Evidence of polyposis or granulations are suggestive of malignant otitis externa.
    • A rash on the limbs or trunk following a tick bite might indicate Lyme disease. See the CKS topic on Lyme disease.

© NHS Institute for Innovation and Improvement