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Q. My taste buds are blunt and could not feel the taste. Does this imply recurrence of Bell's palsy?

Answered by
Dr. Bharat Patodiya
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 13, 2020

Hello doctor,

I had Bell's palsy before few months, and it resolved within two months. I was treated by a neurologist then. But now I feel that my taste buds are blunt and I cannot taste very well, within the past day or so. I have no other symptoms of Bell's palsy yet, but this is how it started back. It was on my left side. I am worried that I am getting Bell's palsy again. Is it possible to get it so soon again? And if I feel it is, what shall I do? Shall I start my steroids and Acyclovir again?

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Hello,

Welcome to icliniq.com.

I can understand your concern. Try finding any other cause of taste loss like consumption of any drug like Metronidazole. If you are sure that no other cause explains it then I will suggest to get NCV (nerve conduction velocity), EMG (electromyography) test because it can pick up delay in nerve conduction earlier than the symptoms. Results are available by the same evening.

Bell's palsy prophylaxis is not recommended anywhere. However, if I imagine myself in your position I would start the medication by the time all these investigations are done. You can also get a detailed neurological examination. Many a time clinical signs can be seen when a patient cannot appreciate symptoms. If it proves to be Bell's then we will have a discussion for further causes of recurrent Bell's.

Thank you doctor,

In addition to Bell's palsy, I had a bout of shingles. The Bell's palsy was triggered by the shingles. The twitching near my eye has decreased somewhat. Perhaps it was related to stress or lack of sleep. But sort of getting an MRI, what sort of blood labs test would you order for a patient, if you had a patient like me present to your office?

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Hello,

Welcome back to icliniq.com.

Since you have an event which explains the onset, so I will not call it Bell's rather more justified is Ramsay hunt. If the shingles history would not have been there then it would be useful to test blood for serology of herpes zoster. Other causes that can cause facial nerve involvement are middle ear infection, tumor, and stroke, all of these will be ruled out on MRI.

Since you do not have other symptoms like heart block, vertigo, and arthritis, I am not thinking on line of Lyme's disease which is also an uncommon cause of facial nerve involvement. As you are a male I am keeping Melkersson-Rosenthal syndrome down in the list of differential for recurrent facial paralysis and facial swelling. Moreover, the treatment is unproven. I will do add here that if you are involved in unprotected sexual activity then HIV test should be done.

Neurologic sarcoidosis was on my mind for recurrent facial palsy (in the absence of history of shingles). We can do ACE (angiotensin-converting enzyme) levels as the first step.

Conclusion: Let us just wait until the MRI report. If totally normal then get ACE and HIV serology (if indicated). How is your facial strength now?


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