Bell’s palsy is a neurological disorder that causes weakness or paralysis on one side of the face. The virus that causes shingles can trigger Bell’s palsy, but the exact connection is unclear.
Bell’s palsy occurs when one of the facial nerves does not work as it should. This causes a sudden onset of symptoms that can include paralysis on one side of the face, a drooping mouth or eyebrow, and drooling on the affected side of the mouth.
Shingles occurs when the varicella-zoster virus, the same one that causes chicken pox, reactivates later in life. Anyone who has had a chicken pox infection may develop shingles because the virus lays dormant in the body following the infection.
Reactivation of the varicella-zoster virus can cause both Bell’s palsy and another similar condition known as Ramsay Hunt syndrome. The two conditions are difficult to tell apart.
This article reviews the potential link between Bell’s palsy and shingles, how Ramsay Hunt syndrome and Bell’s palsy compare, treatment options, and more.
It is possible that when shingles occurs, a person may develop Bell’s palsy.
The exact pathology or cause of Bell’s palsy is unknown. However, experts suspect that the cause may relate to the reactivation of the varicella-zoster virus or an immune disorder.
An older study from 2010 notes that shingles is a leading cause of Bell’s palsy worldwide. In the study of over 170 people with Bell’s palsy, 1.7% were positive for the varicella-zoster virus.
A recent smaller study from 2022 found that the rate of virus reactivation in people with Bell’s palsy was 12.76%.
Ramsay Hunt syndrome and Bell’s palsy are two neurological conditions that can occur due to the reactivation of the varicella-zoster virus and that cause facial weakness or paralysis. The two conditions can be difficult to tell apart and can lead to misdiagnosis.
Causes and symptoms
The only cause of Ramsay Hunt syndrome is a shingles infection. In contrast, Bell’s palsy could occur due to the reactivation of the virus or the presence of other underlying causes, such as an immune system disorder.
Ramsay Hunt syndrome is paralysis of the facial nerve plus a rash around the mouth or ear. By contrast, Bell’s palsy is paralysis of the facial nerves without any visible rash.
The paralysis in Ramsay Hunt syndrome is typically longer-lasting and more severe.
Some estimate that up to 50% of people with Ramsay Hunt syndrome initially receive the wrong diagnosis, and many more do not receive follow-ups from doctors. It is also possible that people with Bell’s palsy may receive a misdiagnosis of Ramsay Hunt syndrome.
Treatments for Bell’s palsy and Ramsay Hunt syndrome are similar, and prompt treatment can improve outcomes. People with Ramsay Hunt syndrome respond best when treatment starts within 3 days, while Bell’s palsy may not require treatment.
Treatments for Bell’s palsy
- pain medications
- antiviral medications
- lubricating eye drops and other eye protection
- physical therapy
- facial massage
- reconstructive surgery
Treatment of associated symptoms
A doctor may recommend or prescribe other medications as needed for other symptoms, such as:
- pain medications
- anxiety medications
- eye drops and eye protection
Ramsay Hunt treatments
Treatment for Ramsay Hunt syndrome typically involves the use of steroids. These can help relieve pain and pressure from swelling on the nerve. Doctors may also prescribe antiviral medication. Even with treatment, a person may experience permanent paralysis or hearing loss.
Several underlying conditions can cause facial paralysis. Some possible causes include:
Shingles, or reactivation of the varicella-zoster virus, can lead to facial paralysis. The virus can cause Bell’s palsy and Ramsay Hunt syndrome, which cause similar paralysis symptoms.
A person who experiences facial paralysis should work with a doctor to determine the underlying cause. Those diagnosed with shingles should talk with a doctor if they experience facial paralysis.
With treatment, both conditions may improve. However, each can leave a person with permanent paralysis.