Analysis of Google Trends data on facial paralysis as a proxy of public interest
Original Article

Analysis of Google Trends data on facial paralysis as a proxy of public interest

Aki Constantine Flame1,2 ORCID logo, Susan Coulson1 ORCID logo, Jennifer Lee2

1Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 2Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital at Westmead, Sydney, NSW, Australia

Contributions: (I) Conception and design: J Lee, AC Flame; (II) Administrative support: J Lee, AC Flame; (III) Provision of study materials or patients: J Lee; (IV) Collection and assembly of data: AC Flame; (V) Data analysis and interpretation: AC Flame; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Aki Constantine Flame, BSc, MD. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St., Westmead, Sydney, NSW 2145, Australia. Email: acflame88@gmail.com.

Background: Facial nerve paralysis (FNP) has a significant impact on patients and their families with functional and aesthetic sequelae. Understanding public awareness and interest in FNP, including its various aetiologies and treatments, remains a challenge. This study utilised Google Trends to analyse search interest regarding FNP and its associated conditions, comparing Australian and global data to assess potential clinical significance.

Methods: Google Trends data from 2004 to 2024 were analysed using relative search volume (RSV) indices for terms related to FNP, including “Bell’s palsy”, “Ramsay Hunt syndrome”, and facial nerve surgery-related queries. Temporal and geographical trends were identified, alongside correlations with media events and rising public interest.

Results: “Bell’s palsy” was the most searched term, showing consistent interest over 20 years with notable peaks during media coverage of celebrity diagnoses (e.g., Justin Bieber and Angelina Jolie) and the coronavirus disease 2019 (COVID-19) pandemic (peak RSV =50). Other terms, such as “Ramsay Hunt syndrome”, exhibited significant spikes in search interest during high-profile cases (RSV =100, June 2022 correlating to Justin Bieber’s diagnosis). Australian interest in surgical procedures, such as “facial reanimation surgery”, was low, contrasting with consistent global interest. Social media trends and hashtags amplified public engagement, reflecting broader interest in FNP and aesthetic concerns.

Conclusions: Google Trends effectively captures public interest in FNP, highlighting correlations with current events and media influence. This tool provides insights into public awareness, potentially shaping patient perceptions and treatment preferences. Increased online engagement may drive demand for surgical interventions, warranting further exploration of its clinical implications.

Keywords: Facial nerve paralysis (FNP); Bell’s palsy; Google Trends; digital health tools; social media engagement

Received: 09 December 2024; Accepted: 11 March 2025; Published online: 02 July 2025.

doi: 10.21037/ajo-24-88

Introduction

Google Trends is a powerful tool that enables the real-time measurement of worldwide search interest in topics generated by users of Google (1). Since its inception in 2006, it has amassed extensive data, facilitating the comparison of search interest by geography, language, and time. Facial nerve paralysis (FNP) is a condition characterised by the impaired function of the facial nerve (cranial nerve VII), which innervates the muscles of facial expression, eye closure and oral competence. Impairment causes issues with communication, eye protection, speech and swallowing (2). FNP is a significant concern for patients, otolaryngologists and other healthcare professionals, yet gauging broader public awareness remains challenging.

The aetiology of FNP is diverse. Idiopathic FNP, commonly referred to as Bell’s palsy, accounts for up to 70% of cases and is proposed to be of viral origin. Other causes include trauma, iatrogenic injury, infection, neoplasms, systemic medical conditions, and congenital factors (3). Given the broad range of causes of FNP, traditional measuring tools may struggle to quantify public understanding.

Google Trends has been used to gauge public awareness and interest regarding (4) health topics, especially during the coronavirus disease 2019 (COVID-19) pandemic. During the COVID-19 pandemic, when FNP was reported following messenger ribonucleic acid (mRNA) vaccination, there was increased media coverage and interest from the public. Seasonality has also influenced search interest on Google Trends’ data on Bell’s palsy (5), as has a government minister’s televised episode of Bell’s palsy in 2021 (6). Google Trends search interest has also correlated with uptake of certain surgical procedures, particularly common cosmetic plastic surgical procedures such as breast augmentation, rhytidectomies and hair transplants (7,8). Limited reporting on facial reanimation and other surgical interventions for facial nerve palsy (FNP) suggests that patients may lack contextual knowledge regarding their treatment options, in contrast to many other medical conditions.

This study aims to identify Australian and global trends in Google Trends search data regarding FNP and its various aetiologies, assessing their clinical significance in patient care. By understanding public interest and knowledge gaps, this analysis may inform targeted patient education, guide resource allocation, and enhance clinician awareness of emerging concerns related to FNP.

Methods

Google Trends

The Google Trends platform was used to gather data on Google searches pertaining to FNP. Google Trends provides data as a relative search volume (RSV) index, which standardizes the popularity of search terms in relation to the total number of searches over a chosen time frame and geographic region. The RSV is scaled from 0 to 100, with 100 representing the peak search volume. A score of 0 is reported if the search volume for a term does not exceed a certain privacy threshold, which is based on the absolute number of searches within the specified period and location. Google Trends raw data can be downloaded for further analysis. The order of words in a search query is not relevant, as Google Trends includes results for any sequence of the search terms. Duplicate searches by the same user are excluded, and repeated queries from the same user within a short time period are removed. Additionally, Google Trends imposes a privacy threshold, not reporting RSV when the absolute search volume is below a certain level.

Google Trends data were analysed over a 20-year period from 2004 to present (September 2024). Subgroup analysis was performed on Australian search data as well as related search data over the last 5 years (September 2019 to September 2024). Related terms were catalogued for each of the four original disease search terms included in the study.

Ethical approval was not required for this study as all data were obtained from publicly available, anonymised sources through Google Trends. No patient-specific or identifiable information was collected, and no direct human participation was involved.

Selection of search terms

Using Google Trends, we filtered results by geographical region and time period, with data available from 2004 to the present. Filters were applied for in Australia and worldwide, and for related terms and searches over the previous 5-year period. Search terms relating to facial nerve pathology and common specific diagnoses were analysed with Google Trends, including facial nerve palsy, Bell’s palsy, facial paralysis and Ramsay Hunt syndrome. Interest in surgery for FNP was assessed with the terms Facial palsy Botox, facial nerve graft, and Bell’s palsy surgery. Related terms and searches were noted for each term.

Results

Figure 1 shows the research volume index (RVI) for FNP and related terms in Australia over the last 20 years. Bell’s palsy was the most searched term, with peaks of interest across the 20-year period, most notably in February 2004 (RSV =31), August 2017 (RSV =43), and August 2021 (RSV =50). Ramsay Hunt syndrome was relatively less searched across the 20-year period, but had a significant spike with RSV of 100 in August 2022. Facial palsy and facial paralysis were not searched to a significant volume during the research period.

Figure 1 Research volume index for facial nerve disease search terms—Australian data 2004–2024.

As seen in Figure 2, facial palsy Botox had a significant spike in December 2005 (RSV =100), but apart from that was relatively lowly searched. Bell’s palsy surgery was similarly lowly searched, with only one spike in October 2009 (RSV =37). Facial nerve graft only had one small peak in September 2018 (RSV =7). More specific terms for surgical procedures like facial reanimation surgery did not show on Google Trends analysis as search numbers in Australia were too low for analysis.

Figure 2 Research volume index for facial nerve surgery search terms—Australian data 2004–2024.

Global interest in facial nerve surgery over the last five years demonstrated more regular interest when compared with Australian data. Bell’s palsy surgery had regular interest over the entire 5-year period, with significant clustering between 2022 and 2023 (peak RSV =73, February and April 2023) and peaks in late December 2020 (peak RSV =100). Facial nerve graft, facial palsy Botox, and facial reanimation surgery were less consistently searched but each had peaks of interest over the five-year period as seen in Figure 3 (peaks of RSV =59, 83 and 64, respectively). Most search interest was concentrated among a few countries or regions, namely India, Pakistan, Canada, the United States, Egypt, Saudi Arabia, the United Kingdom, Australia, South Africa, South Korea, and Hong Kong. Hong Kong had a particularly large proportion of interest in facial palsy Botox, while South Korea’s interest in facial nerve graft was highest.

Figure 3 Research volume index for facial nerve surgery search terms—global data 2019–2024.

Recurring related terms included other related medical conditions, Justin Bieber, COVID-19 and the COVID-19 vaccine as seen in Table 1 below.

Table 1

Related queries for disease search terms

Search term Top related queries Rising related queries
Bell’s palsy Bell’s, Bell’s palsy, Bell’s palsy causes, What is Bell’s palsy, Bell’s palsy treatment, Covid Bell’s palsy, Bell’s palsy symptoms, facial palsy, Bell’s palsy, vaccine, Bell’s palsy stroke, stroke, Bell’s palsy cause, Bell’s palsy nerve, Bell’s palsy eye, Covid vaccine, Covid vaccine Bell’s palsy, what causes Bell’s palsy, Bell’s palsy pain, Bell palsy, Bell, ICD 10 Bell’s palsy, Bell’s palsy vs. stroke, Bell’s palsy meaning, symptoms of Bell’s palsy, causes of Bell’s palsy Covid Bell’s palsy, Covid vaccine, Covid vaccine Bell’s palsy, Pfizer Bell’s palsy, Pfizer vaccine Bell’s palsy, Covid vaccine and Bell’s palsy, Bell’s palsy Covid vaccine side effects, Covid 19 Bell’s palsy, Covid vaccine side effects, Bell’s palsy after Covid vaccine, Pfizer vaccine, Bell’s palsy Covid vaccination, Pfizer Covid vaccine, Bell’s palsy from Covid 19 vaccine, Justin Bieber face, Covid vaccine Bell’s palsy FDA, can Covid cause Bell’s palsy, Bell’s palsy Covid vaccine CDC, can Covid 19 cause Bell’s palsy, Justin Bieber, Bell’s palsy treatment guidelines 2021, Bell’s palsy vaccine, can you get Bell’s palsy from Covid vaccine, Bell’s palsy treatment 2020
Facial nerve palsy Bell’s palsy nerve, Bell’s palsy facial nerve, Bell’s palsy, Bell’s palsy nerve, Bell’s palsy, facial cranial nerve, facial palsy causes, facial nerve palsy causes, cranial nerve, cranial nerve palsy, facial palsy treatment, facial nerve palsy treatment, facial paralysis, facial nerve paralysis, facial palsy symptoms, facial nerve palsy symptoms, causes of facial palsy, causes of facial nerve palsy, trigeminal nerve, trigeminal nerve palsy, facial nerve lesion, facial nerves, stroke, UMN facial palsy, UMN facial nerve palsy Bieber, Ramsay Hunt, syndrome Bieber, syndrome Justin Bieber, Ramsay Hunt syndrome Justin Bieber, Justin Bieber Ramsay Hunt, Justin Bieber, Ramsay Hunt syndrome Justin, Ramsay Hunt syndrome Covid, Bieber paralysed, Justin Bieber paralysed, Ramsay Hunt syndrome Justin Bieber, Justin Bieber, Justin Bieber disease, Hailey Bieber, Justin Bieber Hailey Bieber, Justin Bieber Health, Justin Bieber news, Justin Bieber paralysis, Justin Bieber illness, what happened to Justin Bieber, Justin Bieber virus, what does Justin Bieber have, Cooper Noriega, Justin Bieber condition, Ramsay Hunt syndrome Covid 19 vaccine
Facial paralysis Facial nerve, facial nerve paralysis, palsy, facial palsy, face paralysis, facial paralysis causes, facial paralysis treatment, Bell’s palsy, what is facial paralysis, paralysis symptoms, facial paralysis symptoms, Justin facial paralysis, Bieber facial paralysis, Justin Bieber, Justin Bieber facial paralysis, Facial Stroke, Stroke, Covid Facial Paralysis, vaccine facial paralysis, facial nerve palsy, causes of facial paralysis, cause of facial paralysis, Ramsay Hunt, Ramsay Hunt facial paralysis, Bell’s palsy Justin facial paralysis, Covid vaccine facial paralysis, facial paralysis Pfizer, Pfizer, Pfizer vaccine facial paralysis, Covid vaccine side effects, Covid vaccine facial paralysis side effects, Justin, Bieber facial paralysis, Justin Bieber facial paralysis daily mail, facial paralysis from Covid vaccine, Bieber facial paralysis, Justin Bieber face, Covid vaccine and facial paralysis, Justin Bieber facial paralysis, Covid facial paralysis, Pfizer vaccine side effects, facial paralysis, Justin Bieber facial paralysis Reddit, Justin Bieber, Justin Bieber news, 4 volunteers Develop Facial Paralysis, four volunteers develop facial paralysis, Covid 19 facial paralysis, vaccine facial paralysis, Justin Bieber, Hailey Bieber
Ramsay Hunt syndrome Bieber, Ramsay Hunt syndrome Justin, Ramsay Hunt syndrome, Bieber syndrome, Justin Bieber, Ramsay Hunt syndrome Justin Bieber, Justin Bieber Ramsay Hunt, Justin Bieber, Ramsay Hunt syndrome causes, what is Ramsay Hunt syndrome, treatment Ramsay Hunt syndrome, Ramsay Hunt treatment, Bell’s palsy, Ramsay Hunt syndrome Bell’s palsy, shingles, Ramsay Hunt syndrome shingles, Ramsay Hunt disease, syndrome De Ramsay Hunt, Ramsay Hunt syndrome cause, Ramsay Hunt syndrome symptoms, Ramsey, Ramsey syndrome, Ramsey Hunt syndrome, Ramsey Hunt, Justin Bieber face, Ramsay Hunt syndrome nerve Bieber, Ramsay Hunt, syndrome Bieber, syndrome Justin Bieber, Ramsay Hunt syndrome Justin Bieber, Justin Bieber Ramsay Hunt, Justin Bieber, Ramsay Hunt syndrome Justin, Ramsay Hunt syndrome Covid, Bieber paralysed, Justin Bieber paralysed, Ramsay Hunt syndrome Justin Bieber, Justin Bieber, Justin Bieber disease, Hailey Bieber, Justin Bieber Hailey Bieber, Justin Bieber health, Justin Bieber news, Justin Bieber paralysis, Justin Bieber illness, what happened to Justin Bieber, Justin Bieber virus, what does Justin Bieber have, Cooper Noriega, Justin Bieber condition, Ramsay Hunt syndrome Covid 19 vaccine

CDC, Centers for Disease Control and Prevention; ICD 10, International Statistical Classification of Diseases and Related Health Problems, 10th Revision; FDA, Food and Drug Administration; UMN, upper motor neuron.

Discussion

This study describes Google Trends data relating to facial nerve disease, treatments and correlation to media events with a particular focus on Australian data. Data collated from the last 20 years demonstrates relative peaks in search interest which are a proxy for public interest and relevance of a certain disease topic (9). Bell’s palsy emerged as the most searched disease-related term with steady interest over the 20-year period. The more technical or literal terms like facial nerve palsy and facial paralysis had relatively lower search interest, and commonly searched related terms for these always featured Bell’s palsy, likely reflecting increased public awareness of the latter. Taken with top and rising related queries, peaks in search traffic can be attributed to current events. Most notable are celebrity diagnoses and events during the COVID-19 pandemic. Peaks in searches for Bell’s palsy in July 2017 likely correlate to Angelina Jolie’s diagnosis, Victor Dominello, NSW State, Australian Government Minister August 2021 and Joel Embiid’s diagnosis in April 2024, while the peak in Ramsay Hunt syndrome in March 2022 correlates with Justin Bieber’s diagnosis (10-12).

In addition to the interest generated by celebrity and high-profile cases, social media has had a profound impact on public attention to facial aesthetics and associated surgery (13). Interest in facial paralysis has been shown to be high across all main platforms including TikTok, Instagram, Facebook, Reddit, and Twitter (now known as X) (14). Reels (short bite-sized videos) and hashtags like ‘#bellspalsy’ and ‘#bellspalsyawareness’ have been trending upwards across platforms over a 5-year period in a study by Knoedler and colleagues (14). Trending hashtags and social media algorithms can amplify online interest, which may potentially translate to a significant improvement in public awareness of FNP as well as its available treatments. It may serve an important role in general patient education regarding options available, details pertaining to treatment and expected outcomes. These factors may have contributed to the correlation of increased social media interest to the uptake of both functional and aesthetic surgical procedures (8). Even the advent of selfie cameras on phones may be drawing more attention to subtle asymmetry in the normal subject’s face. Smartphone selfies provide an inverted mirror image of the subject, with some distortion of facial features. However, people preferred images of themselves taken on a conventional front facing camera compared with the inverted selfie image. Patients have then consulted with plastic surgeons based on their own perception of an asymmetric face seen in selfie photos. (15,16). More online and social media content regarding FNP may help dispel misinformation and guide clinicians to their patients’ main concerns and guide their approach to patient education.

The increased search volume during the COVID-19 pandemic was most likely related to media coverage of the Australian rollout of the mRNA vaccine in 2021 (17). Although a rare association between Bell’s palsy and COVID-vaccination was reported in the scientific literature, disproportionate and at times, inaccurate media coverage resulted in Google search interest for Bell’s palsy with RSV of 50 in August 2022. This occurred despite no definitive causal link being established, with reported rates at that time likely reflecting the normal background rate of Bell’s palsy in the community (18,19).

Australian interest in surgery for FNP was relatively low over the last 5 years based on Google Trends data. Surgery is not generally the first-line treatment of FNP, with data from an Australian multidisciplinary facial nerve clinic demonstrating that most cases are managed non-surgically. The more severe cases requiring surgery are often secondary to iatrogenic injury rather than the type of cases as we are describing here (20). Whether higher rates of Trends interest correlate to higher rates of facial nerve surgery in the future remains to be seen, although this trend has been noted with certain cosmetic plastic surgical procedures like breast augmentation, face lift and rhinoplasty (7). While different in nature to purely cosmetic surgery, it is possible that demand for surgery, or at least understanding of the treatment options and expected outcomes, may increase as public awareness of FNP increases, as measured through online engagement (14,21).

A key consideration when interpreting Google Trends data is whether increases in search interest for FNP-related terms reflect a true rise in public concern or merely follow broader trends in internet usage. Google Trends reports data as RSV, which is normalized to the total search activity at a given time (1). However, overall internet access has increased significantly over the past two decades, which may contribute to apparent trends in search interest. Ideally, normalisation against a stable reference term (e.g., “weather” or “news”) or Google’s total search volume growth would allow for better contextualization of these findings. While such direct normalisation is not available through Google Trends, proxies such as Google’s publicly available search statistics and stable reference keywords could potentially be used to address this issue. Future research could benefit from comparing FNP-related searches to high-frequency search terms unrelated to health, helping to distinguish true increases in interest from background internet trends. Additionally, integrating alternative datasets, such as social media trends or online forum discussions, may help verify whether increased online engagement translates into changes in real-world healthcare behaviour.

While Google Trends provides valuable insights into public interest and awareness regarding FNP, several limitations must be acknowledged. Firstly, Google Trends does not provide raw search volume data, making it difficult to determine absolute interest levels. The platform also applies privacy thresholds and data smoothing, which may obscure smaller fluctuations in search activity. Additionally, search behaviour is influenced by various external factors, including media coverage, public health policies, and regional internet usage patterns, which may introduce biases. A key limitation of this study is the lack of validation with real-world data such as incidence rates, clinic presentations, or surgical intervention statistics. Future research should aim to correlate Google Trends data with hospital admissions, consultation rates, and patient-reported experiences to assess the true impact of online search interest on healthcare-seeking behaviour. Incorporating social media analytics and survey-based methodologies may further enhance understanding of patient perceptions and their decision-making processes regarding FNP treatment options.

Conclusions

Google Trends is an emerging tool that can aid to quantify interest in medical disorders and treatment. Its application to FNP demonstrates strong correlations with current events of interest to the public. This may prove a useful tool in our future understanding of patient perceptions of disease, understanding of available treatments and expected outcomes.

Acknowledgments

None.

Footnote

Peer Review File: Available at https://www.theajo.com/article/view/10.21037/ajo-24-88/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://www.theajo.com/article/view/10.21037/ajo-24-88/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Ethical approval was not required for this study as all data were obtained from publicly available, anonymised sources through Google Trends. No patient-specific or identifiable information was collected, and no direct human participation was involved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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doi: 10.21037/ajo-24-88
Cite this article as: Flame AC, Coulson S, Lee J. Analysis of Google Trends data on facial paralysis as a proxy of public interest. Aust J Otolaryngol 2025;8:27.

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