Here is the content of the original posts on the Wedge mouthpiece blog.
A while back someone called me thinking they had Bellís palsy. I thought at the time that this was really something that every brass player should know about. So here is some essential information you should know.
What is Bellís palsy?
Bellís palsy is a condition in wich the nerve that controls the movements of the face becomes injured. The result is facial drooping on the affected side, which can be mild or severe. The result can be an inability to play a brass instrument. Most cases are temporary, but in some cases the effect is permanent. There are things you can do to improve the outcome if you act quickly, which is why it is important to know about.
What causes Bellís Palsy?
Bellís palsy results from inflammation of the facial nerve. The cause is usually a virus, of which several are impicated, including the viruses that cause cold sores, genital herpes, shingles, and others. Swelling of the nerve at the point where it passes through the tight opening where it exits the skull causes damage to the nerve and itís coverings, resulting in temporary or permanent paralysis of supplied muscles.
How can you tell you have Bellís palsy?
Bellís palsy usually comes on over a period of hours to days. Sometimes people just rwake up with a weak of drooping face, difficulty closing the eye, and occasionally a decreased sense of taste on the front of the tongue. When it comes on suddenly it is very difficult for you to know if you have Bellís palsy or a more serious stroke involving the brain. In either case this type of symptom should prompt you to go immediately to the nearest emergency department right away. In both cases early treatment can improve outcome.
Will Bellís palsy get better?
The prognosis of Bellís palsy is related to the severity of the symptoms. Milder cases tend to do better. Poeple with only partial paralysis have a 94 percent rate of return to normal function. Only 60 percent of those with complete paralysis return to normal. These figures apply to normal appearance. It is difficult to know if the same proportion of brass players would report the same rate of return to normal playing strength. Return to normal strength often takes several months. If some improvement is not noticed by 3 weeks the prognosis for recovery is not as good.
What can you do to improve outcome?
The most important thing you can do is to seek medical attention as soon as possible after symptoms are noticed. There are two drugs that are beleived to help, but they must be started within 3 days of the onset of symptoms, and the sooner the better.
Prednisone is a steroid that has been shown to increases the chances of full recovery in several studies (recovery 83% with prednisine and 64% without prednisone in one study). Treatment usually lasts for 7 to 10 days.
Antiviral drugs such as Valacyclovir may also help, but the evidence is less compelling than for steroids. However, given what is at stake for brass players if recovery is not complete I would certainly take an antiviral along with prednisone if I had symptoms.
Other treatments, such as excercises, surgical decompression of the nerve, and electrical nerve stimulation have not shown enough benefit to make them recommended therapies. One study suggested that hyperbaric oxygen might work. The jury is still out on that one. I actually have a plan to do a study looking at the use of hyperbaric oxygen for the treatment of Bellís palsy in a high risk group of patients.
Is there anything else a player can do while waiting for recovery?
Keep playing if you can. Although I am not aware of any evidence that playing will speed recovery it probably will not hurt and could help the partially devervated muscles to stay strong while the nerve recovers. Using something like the Warburton PETE might also help to strengthen the muscles that remain innervated. Some players have reported that they actually switched to trombone or an extra large trumpet mouthpiece because they seemed better able to paly on the larger mouthpiece with the partial paralysis.
The bottom line
Bellís palsy can be a real problem for brass players. Most players do eventually get better over several months, but it is important to get prompt medical attention to rule out other more serious conditions. Prognosis is improved by starting on steroids and antiviral medications within 72 hours.