Bell's Palsy Diagnosis and Management

Definition and Characteristics

• Bell's palsy is defined as an acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours without an identifiable cause, and is typically self-limited, with most patients showing some recovery within 2-3 weeks and complete recovery within 3-4 months, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
• The American Academy of Otolaryngology-Head and Neck Surgery notes that Bell's palsy affects men, women, and children but is more common in those 15-45 years old, those with diabetes, upper respiratory ailments, compromised immune systems, or during pregnancy 1

Etiology

• The exact cause of Bell's palsy remains unclear, but facial nerve inflammation and edema within the narrow canal of the temporal bone is thought to lead to nerve compression, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 3

Chronic Sinusitis Complications

• The American College of Radiology defines chronic sinusitis as inflammation lasting >90 days with persistent respiratory symptoms such as cough, rhinorrhea, or nasal obstruction 4, 5
• The American College of Radiology notes that the most serious complication of chronic sinusitis is intracranial extension of infection, and that sinusitis complications can include meningitis, encephalitis, epidural and subdural empyema, orbital abscess, brain abscess, and dural sinus thrombophlebitis 5, 6

Differential Diagnosis and Clinical Implications

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that Bell's palsy is diagnosed when no other medical etiology is identified as a cause of facial weakness, and that other conditions that may cause facial paralysis include stroke, brain tumors, tumors of the parotid gland or infratemporal fossa, cancer involving the facial nerve, and systemic and infectious diseases including zoster, sarcoidosis, and Lyme disease 1
• The American College of Radiology suggests that imaging studies (CT or MRI) may be necessary to rule out other causes of facial weakness when symptoms are atypical, recurrent, or persist for 2-4 months 7
• For patients presenting with facial weakness and chronic sinusitis, the American Academy of Otolaryngology-Head and Neck Surgery and the American College of Radiology recommend a thorough evaluation to determine if the facial weakness is due to a direct complication of sinusitis or is coincidental, and that treatment should be directed at the underlying cause 1, 7, 6