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“It suddenly struck me that that tiny pea, pretty and blue, was the Earth. I put up my thumb and shut one eye, and my thumb blotted out the planet Earth. I didn't feel like a giant. I felt very, very small.” – Neil Armstrong (1930-2012)

Fresh Reads from the Science 'o sphere!

Monday, January 21, 2008

Kissed By The Bell

Everyone knows that pain is awful. Pain sucks.

Do you know what else sucks?


It sucks in a weird and disturbing way.

Ever since my last bout with a particularly nasty cold, I've had this pukey throbbing pain at the right back of my head that didn't go away.

Four days ago my tongue suddenly went numb. Everything I ate had a strangely smooth texture and tasted rather bland. I thought at that time that I somehow burnt my tongue real bad. In addition, my hearing felt unbalanced - the volume level of both ears don't seem to match up, especially for loud sounds.

Then yesterday, things took a turn for the worse. While working in the lab, I noticed that my right eye felt dry and blurry. When I checked it out in the toilet mirror, I discovered to my horror that my smile/grimace was not symmetrical!

I couldn't pull the right corner of my mouth any higher. Something is affecting a whole bunch of facial functions.

Time to see a doctor.

It turns out that I've caught Bell's Palsy.

Something has caused my facial nerve (cranial nerve VII) to become inflamed, probably viruses from the cold last month.

Due to the fact that the facial nerve runs along a narrow bony canal in the skull, inflammation can cause the nerve to become compressed against the bone, resulting in impaired function of downstream targets such as facial and eyelid muscles.

It is also responsible for carrying sensory signals from part of the tongue and ear to the brain, so those systems are affected as well.

Symptoms of Bell's Palsy include the classic "Bell's smile" (shown above). Other diagnostic features include...

...asymmetrical eyebrow lift. Notice my left eyebrow can lift higher and has deeper wrinkles than my weakened right eyebrow.

This feature helps to differentiate Bell's Palsy from stroke, which doesn't display this asymmetry since stroke injury is in the brain and forehead muscles are innervated by both sides of the brain. In a stroke scenario, eyebrow lifts are usually balanced...

...and inability to close the right side of my mouth fully.

It feels really bizarre to leak water from the right part of my lip when brushing my teeth.


The good news is that Bell's Palsy usually goes away by itself, but it can take weeks or even months to recover. Anti-viral and anti-inflammatory drugs may help a little, but doesn't speed up the process by much.

Well that sucks.

Now not only do I have to live with a twisted mind, I have to endure a twisted face too.

But to make the best out of my misery, Fresh Brainz is happy to bring you this public service announcement about Bell's Palsy:

1. If your tongue feels numb for no obvious reason, go see a doctor immediately.

2. If your facial expressions suddenly become asymmetrical or paralysed, go see a doctor immediately.

Early detection enhances recovery.

P.S. While studying in Canada, my friends and I often do funny impressions of then Prime Minister Jean Chr├ętien because of his distinctive twisted mouth. I didn't know at that time that he once suffered from Bell's Palsy. Apparently years later the bad karma has caught up with me, tsk tsk...

Guess who else had Bell's Palsy before?

Pierce Brosnan.

Would you like to know more?
- Detailed article about Bell's Palsy from the University of Texas


angry doc said...

Take a pic of yourself with your eyes closed too. Go on. :)

Lim Leng Hiong said...

You mean the lop-sided wrinkle that appears on the bridge of my nose when I close my eyes? Yeah it looks really odd.

angry doc said...

One eyeball will still be exposed when you shut your eyes. o_=

Anonymous said...

try laughing out loud? -LH

Lim Leng Hiong said...

To Angry Doc:

Yup, my right eye doesn't close tightly enough. I've been using eye drops for days.

To LH:

Why??? I'm not that masochistic...

blacktag said...

Hope you're on steroids!

Volume 357:1598-1607
New England Journal of Medicine October 18, 2007

Early Treatment with Prednisolone or Acyclovir in Bell's Palsy


Background Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis (i.e., Bell's palsy), but their effectiveness is uncertain.

Methods We conducted a double-blind, placebo-controlled, randomized, factorial trial involving patients with Bell's palsy who were recruited within 72 hours after the onset of symptoms. Patients were randomly assigned to receive 10 days of treatment with prednisolone, acyclovir, both agents, or placebo. The primary outcome was recovery of facial function, as rated on the House–Brackmann scale. Secondary outcomes included quality of life, appearance, and pain.

Results Final outcomes were assessed for 496 of 551 patients who underwent randomization. At 3 months, the proportions of patients who had recovered facial function were 83.0% in the prednisolone group as compared with 63.6% among patients who did not receive prednisolone (P<0.001) and 71.2% in the acyclovir group as compared with 75.7% among patients who did not receive acyclovir (adjusted P=0.50). After 9 months, these proportions were 94.4% for prednisolone and 81.6% for no prednisolone (P<0.001) and 85.4% for acyclovir and 90.8% for no acyclovir (adjusted P=0.10). For patients treated with both drugs, the proportions were 79.7% at 3 months (P<0.001) and 92.7% at 9 months (P<0.001). There were no clinically significant differences between the treatment groups in secondary outcomes. There were no serious adverse events in any group.

Conclusions In patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. (Current Controlled Trials number, ISRCTN71548196 [] .)

Lim Leng Hiong said...

To Blacktag:

Thanks for your concern. Yes, I'm on a week's dose of prednisolone and acyclovir.

I have this sudden urge to become a world-class sprinter...

Anonymous said...

laugh may stimulate facial nerves..? -LH

Lim Leng Hiong said...

To LH:

Thanks for your suggestion; I'm exercising my face regularly to keep the facial muscles busy...

Anonymous said...

My sympathies.

I just lost my ability to hear with my right ear (currently about 35% recovered.)

Similar to you, I got anti virals, steroid, and some sort of nerve booster.

Must be good being an ENT specialist. Can't tell me what exactly is wrong, yet can happily charge consultation and medical procedure fees (+ repeat visits!).

Lim Leng Hiong said...

To Anon 3:46, welcome to Fresh Brainz and I wish you a speedy recovery!

JM Ridlon said...

Hope you have a speedy recovery!

Lim Leng Hiong said...

To JM:

Appreciate your concern. Thanks!

Onlooker said...

Get well soon.
1999 PDF second page From the OSHA site.
Remember to get the vaccination shots if you need to handle animals.
The eye drops are the most important remember to use them to moisturize your eyes and wear sunglasses to protect the eye from excessive exposure to light.
Happy chinese new year

Lim Leng Hiong said...

To onlooker:

Welcome to Fresh Brainz! Thanks for your concern, I'm getting better now.

Anonymous said...


i was diagnosed with bell's over a week ago. i insisted on an mri after the doctor told me to take prednisone, valtrex, and wait it out. i had the mri, negative for stroke or tumor. i decided to take the steroids ( much fun) and not the antiviral. it seems so vague and unproven a diagnosis to be taking all that toxic medication. just would like to know, do you think it's a mistake not talking the anti-viral? it may be too late now anyway as it's more than the first three days.
one week later and full of prednisone, my eye is worse ( unbelievably teary, not dry), and my face is crooked when i speak. ( pulled to one side).

ok, this is hell.
any advice?