Regarding Bell's palsy...

A 42-year-old woman presents as she has noticed a 'droop' in the right side of her face since she woke up this morning. There is no associated limb weakness, dysphagia or visual disturbance. On examination you notice right-sided upper and lower facial paralysis.

Which one of the following features would be most consistent with a diagnosis of Bell's palsy?
A. Vesicular rash around the ear
B. Hyperacusis
C. Sensory loss over the distribution of the facial nerve
D. Pins and needles in the right arm
E. Rhinorrhoea

Answer:
B. Hyperacusis

Discussion: A vesicular rash around the ear would suggest a diagnosis of Ramsey Hunt syndrome. Hyperacusis is seen in around a third of patients with Bells palsy

Bell's palsy may be defined as an acute, unilateral, idiopathic, facial nerve paralysis.

The etiology is unknown although the role of the herpes simplex virus has been investigated previously.

The peak incidence is 20-40 years and the condition is more common in pregnant women.

Clinical Features
 lower motor neuron facial nerve palsy - forehead affected
 patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, and hyperacusis

Management
 in the past a variety of treatment options have been proposed including no treatment, prednisolone only and a combination of aciclovir and prednisolone
 following a National Institute for Health randomized controlled trial it is now recommended that prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell's palsy. Adding in aciclovir gives no additional benefit
 eye care is important - prescription of artificial tears and eye lubricants should be considered

Prognosis
 if untreated around 15% of patients have permanent moderate to severe weakness