Bell's palsv or acute idiopathic lower motor neuron facial palsy is a common cause of facial palsy seen in clinical practice. The cause of this disease is not exactly known though there arc many theories regarding Ils etiology. In this article, we present the theory of "Tertiary is chacmia " in eases of pertinent Bell's palsy. Our concept of Tertiary ischaemia is further supported by histological findings of the nerve sheath biopsy taken during surgical decompression In eases of Bell' s palsy. The procedure, of performing posterior tympanotomy and improving the exposure of the middle ear structures therein is also explained.