Recurrent Bell's Palsy: Can Bell's Palsy Recur?

Bell's palsy is a sudden and temporary paralysis that usually affects the facial muscles on one side of the face. In most cases, it occurs only once and resolves on its own within a few weeks. However, in some people, Bell's palsy can recur years later. This condition is called “recurrent Bell's palsy.” In our blog post, we discuss in detail why Bell's palsy may recur, who is more likely to experience it, and what treatment methods are used in recurrent cases. You can also find information about how to recognize the early signs of recurrent Bell's palsy, the diagnosis process, and preventive measures that can be taken. We wish you all happy reading and healthy days.

What Is Recurrent Bell’s Palsy?

Recurrent Bell's palsy is a condition that occurs in a person who has previously had facial paralysis, when the facial nerve is affected again on the same or opposite side. This condition usually develops as a result of the facial nerve (n. facialis) temporarily losing its conduction function due to inflammation or edema, and even if the nerve has completely healed after the first attack, some people may experience recurrent paralysis attacks at certain intervals. Although the exact cause of this condition is unknown, factors such as genetic predisposition, viral infections (especially herpes simplex virus), diabetes, immune system disorders, or nerve canal narrowing are thought to play a role.

In this context, individuals who experience recurrent Bell's palsy may experience symptoms such as weakness in the facial muscles, asymmetry, inability to close the eyelid, and loss of facial expression in each new attack. While some patients may fully recover from the attacks, others may develop permanent muscle weakness or involuntary muscle movements (synkinesis) due to nerve damage. Therefore, individuals experiencing recurrent facial paralysis should be thoroughly evaluated by neurologists and ear, nose, and throat (ENT) specialists to determine the underlying causes. Finally, early diagnosis, medication, physical therapy, and lifestyle adjustments can help preserve nerve function and reduce the risk of recurrence.

How Common Is Recurring Bell’s Palsy?

Recurrent Bell's palsy is a relatively rare condition, occurring in approximately 7 to 15 percent of all Bell's palsy cases. This means that 1 in 10 people who experience facial paralysis may encounter a similar attack in later years. This is because the first two years after the initial paralysis are the period with the highest likelihood of recurrence. In this context, recurrent Bell's palsy usually occurs on the same side, but in some cases, it can also affect the opposite side of the face. Factors that increase this risk of recurrence include genetic predisposition, diabetes, hypertension, chronic viral infections (especially herpes simplex virus), weakened immune system, and stress.

Additionally, since inflammation and edema occur in the nerve tissue after each recurrent attack, the nerve's recovery time may be prolonged, and some individuals may develop permanent facial expression disorders. Therefore, patients who experience facial paralysis multiple times should undergo a detailed neurological evaluation.

Why Does Bell’s Palsy Reoccur?

The most important reason for recurrence of Bell's palsy is that the underlying factors affecting the facial nerve are not completely eliminated. This is because in most cases, Bell's palsy is caused by the reactivation of viruses in nerve cells, such as the herpes simplex virus (HSV-1). In such cases, triggering factors can lead to the reactivation of inflammation on the nerve. As a result, edema, compression, and conduction disorders may develop in the facial nerve again, causing the palsy to recur.

Additionally, chronic health problems such as diabetes, hypertension, multiple sclerosis, and Lyme disease can also pave the way for the facial nerve to be affected again. In some individuals, the nerve canal is anatomically narrow, meaning even minor inflammation can create pressure on the nerve and increase the risk of paralysis. Therefore, it is crucial for individuals who have experienced Bell's palsy to boost their immunity, manage stress, control chronic diseases, and consult a doctor at the first sign of symptoms to prevent recurrence.

Bell’s Palsy Recurrence Symptoms

As with any disease, recurrent Bell's palsy has its own specific symptoms. These symptoms are as follows:

• Sudden onset of muscle weakness or immobility on one side of the face
• Drooping of the corner of the mouth or asymmetry when smiling
• Inability to fully close the eyelid or dryness, watering sensation in the eye
• Numbness, tingling, or burning sensation in the face
• Speech disorder or inability to pronounce words clearly
• Decreased sense of taste or strange taste in the mouth
• Pain behind the ear or along the jawline
• Excessive sensitivity to sounds (hyperacusis)
• Twitching or involuntary movements of the facial muscles (synkinesis)
• Recurrence of similar symptoms on the side not affected by the previous stroke

Bell’s Palsy Recurrence Diagnosis

The diagnosis of recurrent Bell's palsy is made through careful evaluation of the patient's history and a comprehensive neurological examination. In a person who has previously had facial paralysis, if similar symptoms reappear, the doctor will first ask whether the paralysis developed on the same side or the opposite side and how long it lasted. Magnetic resonance (MR) imaging is then performed. This allows other possible causes, such as tumors, vascular compression, infection, or demyelinating diseases, to be ruled out.

Blood tests also play an important role in the diagnostic process; investigations are performed to identify underlying causes, particularly Lyme disease, diabetes, viral infections (HSV, EBV, CMV), and immune system disorders. Furthermore, when necessary, electromyography (EMG) testing is used to evaluate the electrical activity of the facial muscles and determine the degree of nerve damage. This comprehensive approach allows for the confirmation of recurrent Bell's palsy and the identification of the cause and severity of nerve damage, enabling the creation of an appropriate treatment plan.

Does Recurring Bell’s Palsy Require Medical Treatment?

Recurrent Bell's palsy is usually a condition that requires medical treatment because the risk of nerve damage increases when nerve inflammation and edema recur. Therefore, treatment initiated early accelerates the recovery process and prevents the development of permanent facial muscle weakness or asymmetry. For this purpose, corticosteroids (especially prednisone) are first used to reduce swelling around the nerve, helping to restore nerve conduction. If the cause of the palsy is thought to be the reactivation of a viral infection, antiviral drugs (acyclovir or valacyclovir) may also be added to the treatment.

In addition, physical therapy and facial exercises are recommended to maintain the flexibility and function of the facial muscles. These exercises support nerve healing while preventing the muscles from developing involuntary movements. Furthermore, in patients who cannot close their eyelids, eye drops or protective lenses are used to prevent corneal dryness and irritation. In this context, recurrent Bell's palsy requires not only symptomatic but also cause-focused comprehensive medical treatment.

What Is the Best Treatment for Recurring Bell’s Palsy?

The best treatment for recurrent Bell's palsy is tailored to the individual based on the cause, severity, and overall health of the patient. At this point, the most effective approach is corticosteroid treatment started early on. This is because these drugs reduce swelling in the facial nerve, restoring nerve transmission and speeding up recovery. If the recurrence is caused by a viral infection (especially the herpes simplex virus), antiviral drugs (acyclovir, valacyclovir) are also added to the treatment. This combination stops the progression of nerve inflammation, reducing the risk of permanent nerve damage.

In addition to medication, physical therapy and facial muscle exercises play a crucial role in restoring nerve function. These exercises help prevent involuntary movements (synkinesis) in the muscles and maintain facial symmetry. Strengthening the immune system, getting adequate sleep, reducing stress, and controlling chronic diseases (such as diabetes) also increase the success of treatment. Ultimately, the best results are achieved through a comprehensive treatment plan that combines early diagnosis, appropriate medication, and regular rehabilitation.

Bell’s Palsy Recurrence Prevention

Preventing recurrence of Bell's palsy is possible by controlling the triggering factors that can affect the facial nerve. Therefore, the most important step is to keep the immune system strong and make the body resistant to infections. To achieve this, it is crucial to eat a sufficient and balanced diet, sleep regularly, avoid stress, and avoid excessive fatigue. This is because stress, sleep deprivation, and a weak immune system can cause the herpes simplex virus, which triggers nerve inflammation, to become active again. Protecting the face from cold weather, wind, or sudden temperature changes also reduces nerve sensitivity.

For people with chronic diseases, especially diabetes, hypertension, or thyroid disorders, regular monitoring of these conditions plays a key role in maintaining nerve health. Experts also note that physical therapy and exercises to strengthen facial muscles after the first Bell's palsy attack reduce the risk of recurrence by supporting nerve circulation. If warning signs such as tingling, pain, or muscle twitching in the face are noticed before symptoms reappear, consulting a neurologist immediately can prevent the palsy with early treatment.

If you would like to learn more about recurrent Bell's palsy, you can contact Dr. Berke Özücer and his team, who specialize in Bell's palsy treatment.