Facial Nerve Disorders: Symptoms, Treatments, and Management

Facial nerve dysfunction

I have been diagnosed with Ramsay Hunt Syndrome for seven and a half months.
Since being hospitalized, I have been continuously receiving rehabilitation therapy and acupuncture treatment, and I am taking B12 supplements.
However, my symptoms have been recovering very slowly.
Currently, I have difficulty fully closing my eyes, and one side of my facial muscles does not move when I smile.
I experience tearing and runny nose while eating, and water spills from the corners of my mouth when I rinse.
Additionally, I have persistent dizziness throughout the day, and I cannot work in front of a computer because my head feels heavy and I experience a sensation of imbalance when moving my head side to side.
I have undergone six sessions of canalith repositioning with no effect and have consulted several ENT specialists without finding a solution.
Another issue is that my sense of taste is distorted; everything tastes sweet, including plain water, and food feels strange in my mouth.
A month after the onset of Ramsay Hunt Syndrome, I developed a thyroid cyst, which was aspirated twice, yielding 18cc and 26cc of fluid, but it has recurred.
I asked the ENT doctor if this is related to my facial nerve dysfunction, and they said it is not, but it did occur after the facial nerve dysfunction began.
I would like to know if there are any solutions for my dizziness and taste issues, as well as recommendations for further treatment.
Thank you.

ken, 50~59 year old female. Ask Date: 2021/04/30

Dr. Cai Zongzhang reply Neurology

Hello Ken! Based on the symptoms described above, they are all sequelae of facial nerve injury.
Continuous follow-up and taking B12 are the correct treatment approaches.
Additionally, good sleep also aids in nerve repair, so please be patient and continue with the treatment.

Reply Date: 2021/04/30

More Info

Understanding facial nerve disorders, particularly in the context of conditions like Ramsay Hunt syndrome, is crucial for effective management and treatment. Ramsay Hunt syndrome is caused by the reactivation of the varicella-zoster virus, which can lead to facial nerve paralysis and other symptoms. In your case, you have been experiencing a range of symptoms for over seven months, including incomplete eye closure, facial muscle weakness, excessive tearing, nasal discharge, and altered taste perception. Additionally, you report persistent dizziness and a sweet taste in your mouth, which can be distressing and impact your quality of life.

Symptoms of Facial Nerve Disorders
Facial nerve disorders can manifest in various ways, including:
1. Facial Weakness or Paralysis: This is often the most noticeable symptom, where one side of the face may droop, making it difficult to smile or close the eye completely.

2. Altered Taste Sensation: Changes in taste, such as a persistent sweet taste, can occur due to nerve damage affecting taste buds.

3. Tearing and Nasal Discharge: Involuntary tearing and nasal discharge can happen due to the loss of control over facial muscles.

4. Dizziness and Balance Issues: Dizziness may arise from vestibular dysfunction, which can accompany facial nerve disorders.

5. Pain and Discomfort: Some individuals experience pain around the ear or in the jaw area.

Treatment and Management
Given your symptoms and the duration of your condition, a multi-faceted approach to treatment is essential:
1. Physical Therapy and Rehabilitation: Continuing with rehabilitation therapy is crucial. Facial exercises can help improve muscle strength and coordination. A physical therapist specializing in facial rehabilitation can provide tailored exercises to enhance recovery.

2. Medications: Vitamin B12 supplementation is beneficial for nerve health, and it seems you are already taking it. Additionally, corticosteroids may be prescribed to reduce inflammation and swelling around the facial nerve, especially if treatment is initiated early.

3. Acupuncture and Alternative Therapies: You mentioned undergoing acupuncture, which can be beneficial for some patients in managing pain and promoting healing. While evidence is mixed, many find it helpful as part of a holistic approach.

4. Management of Dizziness: Since you are experiencing dizziness, it may be worthwhile to consult a vestibular rehabilitation specialist. They can provide exercises designed to improve balance and reduce dizziness.

5. Taste Alterations: The sweet taste you are experiencing may be linked to nerve damage affecting taste perception. While this symptom can be frustrating, it often improves over time as the nerve heals. Keeping a food diary to track changes in taste can be helpful for discussions with your healthcare provider.

6. Regular Follow-ups: Continuous monitoring by a neurologist or an ear, nose, and throat (ENT) specialist is essential. If symptoms persist or worsen, further imaging studies, such as MRI, may be warranted to rule out other underlying issues.

7. Thyroid Monitoring: Regarding your thyroid cysts, while they may not be directly related to your facial nerve issues, it’s important to keep monitoring them, especially since you have undergone procedures for them. Regular follow-ups with an endocrinologist may be beneficial.

Conclusion
In summary, managing facial nerve disorders, particularly in the context of Ramsay Hunt syndrome, requires a comprehensive approach that includes physical rehabilitation, medication, and regular medical follow-ups. While recovery can be slow, many individuals experience significant improvements over time. It’s important to maintain open communication with your healthcare providers and advocate for your health needs. If symptoms persist or new ones arise, do not hesitate to seek further evaluation. Your well-being is paramount, and with the right support and treatment, you can work towards regaining function and improving your quality of life.

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