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Facial Paralysis and Inner Ear Conditions

Facial paralysis occurs when the facial nerve is damaged and unable to send messages to the muscles of the face that create facial expressions. This problem can occur for several different reasons. Some causes include: tumor, trauma, stroke, or genetic disorders.

The most common cause of facial paralysis is due to Bell Palsy. While most of the time, Bell Palsy patients recover fully, research tell us that about 20-30% have lasting weakness or paralysis.

I first started treating people with facial paralysis because I was a vestibular specialist. The vestibular system or inner ear balance system is innervated by cranial nerve 8 (the Vestibular Nerve). The muscles of the face used for facial expression are innervated by cranial nerve 7 (the Facial Nerve). These 2 nerves run side by side on their way to the brain in a tunnel in the bone called the Internal Auditory Canal (IAC). This is a very narrow space, with only enough room for the nerves to travel. If a tumor is growing in this small place, or an infection travels to this area, both nerves can be damaged. We see this with large acoustic neuroma tumors, or with infections such as Ramsey Hunt Syndrome.

When facial paralysis does occur, it can take a lot of time for the nerve to heal. The first signs of movements of the face can be only just a flicker, but as the nerve heals, the movements can become stronger. Working with a physical therapist who has special training in treating facial paralysis can help improve the outcome for patients with this problem. They can teach a person what to expect while they are recovering, how to do stretches to ease pain and tightness in the face, how to retrain the muscles to move in a symmetrical way with the unaffected side of the face, and how to manage a condition called synkinesis (when facial muscles which should not be working when making a certain expression try to “help” anyway).

*Sculpture by Jun Kaneko 2007, Untitled Head in Glazed Ceramic and Steel