Other signs may be linked to the cause of the paralysis, such as vesicles in the ear, which may occur if the facial palsy is due to shingles.

It is typically diagnosed clinically, in patients with no risk factors for other causes, without vesicles in the ear, and with no other neurological signs.

[8] The first sign of about 80% of Lyme infections, typically one or two weeks after a tick bite, is usually an expanding rash that may be accompanied by headaches, body aches, fatigue, or fever.

Reactivation of latent virus within the geniculate ganglion is associated with vesicles affecting the ear canal, and termed Ramsay Hunt syndrome type 2.

[6] In addition to facial paralysis, symptoms may include ear pain and vesicles, sensorineural hearing loss, and vertigo.

Antibiotics are used to control the otitis media, and other options include a wide myringotomy (an incision in the tympanic membrane) or decompression if the patient does not improve.

In the case of inflammation the nerve is exposed to edema and subsequent high pressure, resulting in a periferic type palsy.

Patients may also present with blood behind the tympanic membrane, sensory deafness, and vertigo; the latter two symptoms due to damage to vestibulocochlear nerve and the inner ear.

While this will inevitably lead to facial paralysis, safe removal of a malignant neoplasm is vital for patient survival.

Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumour, and it should be managed accordingly.

Central facial palsy can be caused by a lacunar infarct affecting fibers in the internal capsule going to the nucleus.

In a clinical setting, other commonly used classifications include: intra-cranial and extra-cranial; acute, subacute and chronic duration.

[17] Central facial palsy can be caused by a lacunar infarct affecting fibers in the internal capsule going to the nucleus.

Facial palsy is considered severe if the person is unable to close the affected eye completely or the face is asymmetric even at rest.

[7] Other studies have found antivirals to possibly improve outcomes relative to corticosteroids alone for severe Bell's palsy.

[7] In those whose blinking is disrupted by the facial palsy, frequent use of artificial tears while awake is recommended, along with ointment and a patch or taping the eye closed when sleeping.

[7][18] Several surgical treatment options exist to restore symmetry to the paralyzed face in patients where function does not return (see section Tumors above).