Is Bell’s Palsy Contagious?

It’s thought that Bell’s palsy results from reactivation of a viral infection. This reactivation is believed to cause inflammation around the facial nerve, leading to compression and the appearance of Bell’s palsy symptoms.

Below, we’ll explore the types of viral infections that are associated with Bell’s palsy.

Herpes simplex virus 1 (HSV-1)

Herpes simplex virus 1 (HSV-1) is the virus that causes cold sores. It’s estimated that 67 percent of people under age 50 have HSV-1 worldwide.

HSV-1 is contagious. It can spread via contact with infected:

• sores
• saliva
• oral surfaces

Although transmission can happen at any time, it’s more likely when cold sores are present.

There’s no cure for HSV-1. The virus remains in your body, lying dormant in nerve cells, some of which are associated with the facial nerve. The virus can occasionally reactivate, leading to cold sores.

Some researchers have detected HSV-1 in up to 50 percent of Bell’s palsy cases that they’ve evaluated.

One small study found HSV-1 DNA present in the saliva of 11 out of 38 people with Bell’s palsy.

Varicella zoster virus (VZV)

Varicella zoster virus (VZV) is the virus that causes chickenpox. It’s also contagious and can be spread by coming into close contact with someone that has an active infection.

There’s now a vaccine for chickenpox, which has led to a significant decrease in new cases.

Like HSV-1, VZV remains dormant in the nerves after your initial infection. The virus can sometimes reactivate later in your life, causing a condition called shingles.

VZV DNA has been detected in samples from people with Bell’s palsy. However, this has occurred in only a small number of study participants.

Epstein-Barr virus (EBV)

Epstein-Barr virus (EBV) is the virus that causes infectious mononucleosis (mono).

It’s one of the most common viruses found in humans, with most people getting the infection at some point in their lifetime.

EBV is contagious. It can be spread to others through contact with bodily fluids containing the virus, most often saliva.

There’s no cure for EBV. Like both HSV-1 and VZV, EBV remains in your body following infection and can occasionally reactivate.

EBV has been associated with conditions impacting the nervous system, including facial palsies.

Some studies have found evidence of EBV or EBV-specific antibodies in people with Bell’s palsy.

Other viruses

In addition to the three viruses we’ve discussed above, there are some others that have been less often linked with cases of Bell’s palsy through both older and newer research. These include:

• cytomegalovirus (CMV)
• measles
• mumps
• adenovirus

While viral involvement is suspected, Bell’s palsy is classified as an idiopathic condition. An idiopathic condition is one that appears with little or no identifiable cause.

If the reactivation of a viral infection is involved in the development of Bell’s palsy, what could possibly trigger it? Some proposed triggers include:

• injury or trauma
• psychological or physical stress
• sleep deprivation
• mild or minor illnesses
• underlying autoimmune conditions

It’s also worth pointing out that there are other conditions that can produce symptoms similar to those of Bell’s palsy. Some examples include:

• direct injury or trauma to the facial nerve
• tumors impacting the facial nerve
• Lyme disease
• Ramsay Hunt syndrome
• Guillain-Barré syndrome
• myasthenia gravis
• sarcoidosis
• stroke

Your doctor will rule out these conditions as a part of their differential diagnosis.

About 70 percent of cases of weakness or paralysis affecting the facial nerve are diagnosed as Bell’s palsy.

The symptoms of Bell’s palsy can vary in intensity from mild to severe. Symptoms typically peak 72 hours after their onset and may include:

• weakness or paralysis on one side of your face, particularly the area of the eyes, forehead, or mouth
• trouble with making facial expressions, closing your eye, or chewing
• drooping of the mouth or eyelid
• drooling
• facial or ear pain
• eye symptoms, which can include dry eyes or increased tearing
• headache
• sensitivity to loud noises
• loss of taste

There are some factors that may increase your risk of developing Bell’s palsy. These include:

• pregnancy, particularly if preeclampsia is present
• diabetes
• hypertension (high blood pressure)
• obesity
• upper respiratory infection, such as the common cold or the flu

There are a few remedies that you can try at home as you recover from Bell’s palsy. These include:

• Over-the-counter (OTC) medications. These can help to ease symptoms such as facial pain or headache. Some examples include acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen (Advil, Motrin).
• Eye care. Symptoms like dry eyes can be relieved with OTC eye drops like artificial tears. If you’re having trouble keeping your eye closed, consider using glasses or an eyepatch to help protect it from injury.
• Massage. Gentle massaging may help to relax the muscles in your face that have been affected by Bell’s palsy.

Some of the treatments that your doctor may prescribe for Bell’s palsy include:

• Corticosteroids. Corticosteroids can help to reduce inflammation around your facial nerve. These are most effective if started within 72 hours of the first symptoms.
• Antivirals. Since viral infections may contribute to Bell’s palsy, you may also be given antiviral medications. Some examples include medications like acyclovir (Zorivax) or valacyclovir (Valtrex).
• Physical therapy. A physical therapist can teach you exercises to help maintain or regain function in affected facial muscles.
• Surgery. Typically, surgery to relieve pressure on the facial nerve isn’t recommended. However, plastic surgery may be used to correct damage due to Bell’s palsy, such as a crooked smile or a drooping eyelid.
• Acupuncture. There’s some evidence that acupuncture may be used to treat Bell’s palsy. However, more research is needed to support this.

It’s estimated that 85 percent of people with Bell’s palsy experience some symptom improvement within 3 weeks.

In the remaining 15 percent, it may take longer to see improvement, sometimes up to 3 to 5 months.

Overall, about 71 percent of people with Bell’s palsy experience a complete recovery. However, some people that have had Bell’s palsy may have permanent facial weakness or paralysis.

Factors that may predict an incomplete recovery include:

• having severe symptoms
• going a longer period of time before symptom improvement is observed
• experiencing persistent pain

It’s possible that Bell’s palsy can recur. This has been estimated to happen in 5 to 15 percent of cases.

The symptoms of Bell’s palsy can be similar to those of a stroke. Because of this, you should seek immediate medical attention if you experience sudden facial paralysis or drooping.

Make an appointment with your doctor if you have facial weakness or drooping that develops over a period of a couple of days and is accompanied by other symptoms of Bell’s palsy, such as:

• drooling
• facial pain
• eye irritation

Bell’s palsy is a condition that causes facial weakness or paralysis. Its exact cause is unknown.

While Bell’s palsy itself isn’t contagious, research has indicated that some types of viral infection may contribute to the condition. These viral infections are contagious and can include HSV-1, VZV, and EBV.

Most cases of Bell’s palsy resolve completely, although some people may have permanent facial weakness or paralysis. Treatment often involves medications and physical therapy.

The symptoms of Bell’s palsy are similar to those of a stroke. Always seek immediate medical care if you have facial paralysis or drooping that comes on suddenly.