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

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.

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?