Ramsay Hunt syndrome

Updated: 2021-10-12

Overview

Facial nerve

The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face.

Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles outbreak affects the facial nerve near one of your ears. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear.

Ramsay Hunt syndrome is caused by the same virus that causes chickenpox. After chickenpox clears up, the virus still lives in your nerves. Years later, it may reactivate. When it does, it can affect your facial nerves.

Prompt treatment of Ramsay Hunt syndrome can reduce the risk of complications, which can include permanent facial muscle weakness and deafness.

Symptoms

Facial paralysis

Facial weakness or paralysis may cause one corner of your mouth to droop. If you're experiencing facial weakness or paralysis, you may have trouble closing the eye on the affected side of your face.

The two main signs and symptoms of Ramsay Hunt syndrome are:

• A painful red rash with fluid-filled blisters on, in and around one ear
• Facial weakness or paralysis on the same side as the affected ear

Usually, the rash and the facial paralysis occur at the same time. Sometimes one can happen before the other. Other times, the rash never occurs.

If you have Ramsay Hunt syndrome, you might also experience:

• Ear pain
• Hearing loss
• Ringing in your ears (tinnitus)
• Difficulty closing one eye
• A sensation of spinning or moving (vertigo)
• A change in taste perception or loss of taste
• Dry mouth and eyes

When to see a doctor

Call your doctor if you experience facial paralysis or a shingles rash on your face. Treatment that starts within three days of the start of signs and symptoms may help prevent long-term complications.

Causes

Ramsay Hunt syndrome occurs in people who've had chickenpox. Once you recover from chickenpox, the virus stays in your body — sometimes reactivating in later years to cause shingles, a painful rash with fluid-filled blisters.

Ramsay Hunt syndrome is a shingles outbreak that affects the facial nerve near one of your ears. It can also causes one-sided facial paralysis and hearing loss.

Risk factors

Ramsay Hunt syndrome can occur in anyone who has had chickenpox. It's more common in older adults, typically affecting people older than 60. Ramsay Hunt syndrome is rare in children.

Ramsay Hunt syndrome isn't contagious. However, reactivation of the varicella-zoster virus can cause chickenpox in people who haven't previously had chickenpox or been vaccinated for it. The infection can be serious for people who have immune system problems.

Until the rash blisters scab over, avoid physical contact with:

• Anyone who's never had chickenpox or who's never had the chickenpox vaccine
• Anyone who has a weak immune system
• Newborns
• Pregnant women

Complications

Complications of Ramsay Hunt syndrome may include:

• Permanent hearing loss and facial weakness. For most people, the hearing loss and facial paralysis associated with Ramsay Hunt syndrome is temporary. However, it can become permanent.
• Eye damage. The facial weakness caused by Ramsay Hunt syndrome may make it difficult for you to close your eyelid. When this happens, the cornea, which protects your eye, can become damaged. This damage can cause eye pain and blurred vision.
• Postherpetic neuralgia. This painful condition occurs when a shingles infection damages nerve fibers. The messages sent by these nerve fibers become confused and exaggerated, causing pain that may last long after other signs and symptoms of Ramsay Hunt syndrome have faded.

Prevention

Children are now routinely vaccinated against chickenpox, which greatly reduces the chances of becoming infected with the chickenpox virus. A shingles vaccine for people age 50 or older also is recommended.

Diagnosis

Doctors often can identify Ramsay Hunt syndrome based on medical history, a physical exam, and the disorder's distinctive signs and symptoms. To confirm the diagnosis, your doctor might take a sample of fluid from one of the rash blisters in your ear for testing.

Treatment

Prompt treatment of Ramsay Hunt syndrome can ease pain and decrease the risk of long-term complications. Medications may include:

• Antiviral drugs. Medications such as acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex) often help combat the chickenpox virus.
• Corticosteroids. A short regimen of high-dose prednisone appears to boost the effect of antiviral drugs in Ramsay Hunt syndrome.
• Anti-anxiety medications. Drugs such as diazepam (Valium) can help relieve vertigo.
• Pain relievers. The pain associated with Ramsay Hunt syndrome can be severe. Prescription pain medications may be needed.

Self care

The following can help reduce the discomfort of Ramsay Hunt syndrome:

• Keep areas affected by the rash clean.
• Apply cool, wet compresses to the rash to ease pain.
• Take an over-the-counter pain reliever or anti-inflammatory drug, such as ibuprofen (Advil, Motrin IB, others).

If facial weakness makes it difficult for you to close one of your eyes, take the following steps to protect your vision:

• Use moisturizing eyedrops throughout the day if your eye becomes dry.
• At night, apply ointment to the eye and tape your eyelid shut or wear an eye patch.

Preparing for your appointment

You're likely to start by first seeing your family doctor. He or she may refer you to a doctor who specializes in nervous system disorders (neurologist) or to an ear, nose and throat specialist (otolaryngologist).

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

• What are your symptoms? When did they start?
• Have you had the sensation that the room is spinning (vertigo)?
• Has your hearing been affected?
• Have you noticed a change in your sense of taste?
• Have you had the chickenpox (varicella) vaccine? When?
• Have you ever had chickenpox? When?
• Are you being treated for any chronic health conditions? If so, what treatments are you receiving?
• Are you pregnant?

What to expect from your doctor

During the physical exam, your doctor will closely examine your face to check for evidence of one-sided paralysis or a shingles rash on, in or around your ear.