Can COVID-19 Cause Bell's Palsy?

Viral infection may be one cause of Bell's palsy, but the connection with the coronavirus that causes COVID-19 is unclear.

COVID-19 is a novel (new) coronavirus, not previously identified in humans, that is responsible for an outbreak of respiratory illness that became a global pandemic in 2020. COVID-19 is different from other coronaviruses that cause mild illness, such as the common cold.

Bell's palsy (also called idiopathic facial palsy) is a condition in which patients experience temporary facial paralysis or weakness on one side of the face because the nerve that controls the muscles of the face becomes injured or fails to work properly.

The most common symptoms of COVID-19 appear about 2 to 14 days after exposure and include:

• Shortness of breath
• Fatigue
• Cough
• Fever or chills

Emergency warning signs that require immediate medical attention (call 9-1-1 or go to a hospital’s emergency department): 

• Difficulty breathing
• Bluish lips or face
• Persistent pain or pressure in the chest
• New confusion or inability to arouse

Less common symptoms of COVID-19 may include: 

• Altered sense of taste and/or smell
• Dizziness
• Headache
• Diarrhea
• Body aches
• Nausea
• Feeling unwell (malaise)
• Loss of appetite
• Sore throat
• Congestion
• Runny nose

Symptoms of Bell’s palsy tend to appear suddenly over a 48 to 72-hour period, usually affect just one side of the face, and may include:

• Sudden weakness of one side of the face
• Drooping of the mouth or lower part of the face
• Drooling
• Inability to close eye (that results in eye dryness)
• Excessive tearing in one eye
• Facial pain or abnormal sensation
• Altered taste/loss of sense of taste on the front of the tongue
• Intolerance to loud noise
• Distorted facial appearance
• Eyebrow sagging

These symptoms may result in distress and social withdrawal among patients. 

At first, COVID-19 was believed to be primarily a respiratory illness. But as the virus has spread across the world, neurological symptoms were reported including headaches, loss of taste, and loss of smell.

There have been rare case reports of Bell's palsy that accompany COVID-19 infection. The connection still remains unclear, but since Bell’s palsy is thought to be caused by viral infections, it may be possible it could be caused by the coronavirus, the virus that causes COVID-19. More study is needed. 

Four cases of Bell’s palsy were reported among the Pfizer and BioNTech vaccine study in mid December 2020, according to the U.S. Food and Drug Administration (FDA). All four cases were in the group that received the vaccine and not the placebo, though that number of cases is not more than would be expected in the general population. 

The FDA is monitoring vaccine recipients for evidence of new cases of Bell’s palsy.