A new study found that COVID-19 vaccines increased the risk of Bell’s palsy. However, it is important to note that the risk of Bell’s palsy was 3X higher in individuals who contracted COVID-19 compared to the vaccinated group. In other words, it’s safer to get the COVID vaccines rather than COVID-19 with respect to Bell’s palsy.
Early in the vaccination effort against COVID-19, the CDC, and other groups, noticed a slight increase in the risk of Bell’s palsy after receiving one of the vaccines. Researchers determined that Bell’s palsy was extremely rare after COVID-19 vaccination and that the condition was almost always temporary.
As I always do, let’s look at the underlying paper for these claims. I also want to be clear as I can, the risks of the COVID-19 vaccines are still far below the risks of the disease itself. This simple equation seems to be ignored by those who will use this paper to condemn the COVID-19 vaccines.
What is Bell’s palsy?
Bell’s palsy is the most common cause of facial paralysis. The condition usually affects just one side of the face.
Symptoms appear suddenly and are at their worst about 48 hours after they start. They can range from mild to severe and include:
- Drooping eyelid or corner of the mouth
- Dry eye or mouth
- Excessive tearing in the eye
- Impaired ability to taste
Scientists have hypothesized that viral infection causes the facial nerve to swell or inflame. There is a higher risk of Bell’s palsy in pregnant or diabetic individuals along with those who have contracted the flu or a cold.
About 75% of patients improve without treatment. Symptoms resolve quickly, usually within two weeks, and full recovery occurs within three to six months. Bell’s palsy may seem frightening, but it is very mild and almost always temporary.
Severe or permanent conditions as a result of Bell’s palsy are extremely rare.
Bell’s palsy and COVID-19 vaccines paper
In a systematic review and meta-analysis (considered to be the top of the hierarchy of biomedical research) published on 27 April 2023 in JAMA Otolaryngology-Head & Neck Surgery, Amir Kheradmand, MD, a neurologist at Johns Hopkins University School of Medicine in Baltimore, and co-authors pooled data from vaccine clinical trials that included 77,525 individuals who received one of the COVID-19 vaccines to determine the odds of developing Bell’s palsy.
Here are the key results from this study:
- Data from the clinical trials showed that individuals who received the COVID-19 vaccines were 3X more likely to develop Bell’s palsy.
- Compared to the vaccinated group, the risk of Bell’s palsy was 3.2X more likely in the group that contracted COVID-19.
- No incidents of Bell’s palsy have been reported in children ages 6 months through 17 years in Moderna and Pfizer mRNA vaccine trials to date.
- However, pooled data from observational studies comparing Bell’s palsy in 13.5 million COVID-19 mRNA vaccine recipients and a matched group of unvaccinated individuals showed no significant increase in the risk of Bell’s palsy.
- No significant difference emerged in Bell’s palsy risk among 23 million first-dose recipients of the Pfizer/BioNTech vaccine compared with 23 million first-dose recipients of the Oxford/AstraZeneca vaccine.
Although the data seems to be contradictory, the larger data pool, with over 13.5 million vaccine recipients, showed that there was no difference in the risk of Bell’s compared to unvaccinated.
Because this type of data will be misused, I need to repeat the conclusions as carefully as I can.
- In clinical trials, the vaccinated group appeared to have a 3X higher (still extremely rare) risk of Bell’s palsy compared to the unvaccinated group. But the group infected with COVID-19 had a 3.2X higher risk of Bell’s palsy compared to the vaccinated group.
- In pooled data from observational studies, which include much larger numbers, the researchers found no difference in the risk of Bell’s palsy between the vaccinated and unvaccinated groups.
This study may seem to give opposing results, but I think the key points must be reiterated — Bell’s palsy is very rare, but the risk is higher in unvaccinated individuals who contract COVID-19.
- Holland NJ, Bernstein JM. Bell’s palsy. BMJ Clin Evid. 2014 Apr 9;2014:1204. PMID: 24717284; PMCID: PMC3980711.
- Marson AG, Salinas R. Bell’s palsy. West J Med. 2000 Oct;173(4):266-8. doi: 10.1136/ewjm.173.4.266. PMID: 11017995; PMCID: PMC1071111.
- Rafati A, Pasebani Y, Jameie M, Yang Y, Jameie M, Ilkhani S, Amanollahi M, Sakhaei D, Rahimlou M, Kheradmand A. Association of SARS-CoV-2 Vaccination or Infection With Bell Palsy: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2023 Apr 27:e230160. doi: 10.1001/jamaoto.2023.0160. Epub ahead of print. PMID: 37103913; PMCID: PMC10141297.