facial paralytics attack after left ear pain

[xlri77]

Last week i had a facial parlytics attack on left side.After this attack my 1) left side lips cannot move,2)my eyelids are completely open,does not blink and becomes watery.Before this attack, I had a pain on back of left ear and had feeling of swollen nerves on back of left ear.I was having high blood pressure (160/90)
Please suggest 1) cause of this attack apart from high blood pressure2)Physiotherpay techniques to heal,presently my doctor is using electrics shock treatement on affectedd areas(is this correct or will this have any side effect)

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Your facial paralysis, as you describe it, is most probably consistent with Bell's palsy.

There are 12 nerves, called cranial nerves, that supply our face. One of these nerves is called the 7th cranial nerve, of facial nerve. It innervates several parts of the face, including the muscles we use for facial expression (smiling, closing the eyes, looking surprised). It also has such functions as helping us perceive taste on part of our tongue, and dampens sounds so that they are not too loud. It is also involved in our eyes tearing and in our mouth watering.

Bell's Palsy (named after the physician who discovered it) is a condition that results from a lack of function of the facial nerve, and the problem leading to this dysfunction can be anywhere from the origin of the nerve to anywhere in its path where it gives of smaller nerves to supply all the areas described above.

Weakness of an entire side of the face (including the forehead, eye, cheek, and neck muscles) occurs. A person with Bell's palsy is unable to raise up their forehead, close their eye, smile, or contract their neck muscle on the affected side.

Many patients complain of sensory symptoms such as numbness or tingling in the face on the same side of the weakness. Where the lesion is determines what additional symptoms there are. If the lesion is close to the origin of the nerve, then in addition to complete weakness of the face (on the same side of the affected nerve), symptoms will include lack of tearing from the eye on the same side. If the lesion involves the nerve prior to where it branches off to the tongue, taste may be involved. And so on.

It could be "idiopathic", meaning having no known, identifiable cause, or secondary to other processes, including but not limited to infections (such as Lyme disease or Herpes infection) or inflammation (such as in the condition called sarcoidosis).  If it is isolated, meaning that no other findings are present, then it is highly unlikely to be due to a stroke, tumor, or other causes. However, if for example, the body on the side opposite of the facial weakness is also weak, the latter causes need to be ruled out.

One concern is that given your ear pain, your facial paralysis is related to an infection, as can occur with infection with the herpes virus HSV. Another concern would be for stroke. In general, a thorough physical examination is required to exclude a stroke as being the cause of the facial weakness, in which case this would be accompanied by abnormalities of eye movement and/or weakness of the other side of the body. This type of stroke could be caused by elevated blood pressure.  

The extent of recovery will depend on the cause, and the age of the patient. In idiopathic cases in younger individuals, complete or near complete recovery of the function of the facial nerve over weeks to 2-3 months is expected. In some cases, there is partial recovery, and much less commonly, there is little recovery of function.

There are treatments available to help increase chance of good recovery, include a type of steroid called prednisone, taken for 10 days, and in some cases, acyclovir, and anti-viral medication. Until the eye can be closed properly, natural tears and ointment should be applied to the eye to protect it.

Evaluation by your primary doctor is recommended with referral to a neurologist as indicated.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.