Three theories explain how hemifacial spasms might occur. The ephaptic transmission theory states that arteries or other obstructions pushing the facial nerve out of place result in electrical activity between neurons, creating synapses where they should not exist. A second theory proposes that compression of the facial nerve causes abnormal activity in axons and dendrites at the base of the nerve. The kindling theory attributes facials spasms, hearing loss, and odd smells or tastes to "scrambled" feedback in the facial nerve following injury or compression.

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