What Is Ramsay Hunt Syndrome?

Medically Reviewed By Heidi Moawad, M.D.
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Ramsay Hunt syndrome is a rare infection affecting the facial nerve, which controls facial movements. It can cause facial paralysis, known as facial palsy. Ramsay Hunt syndrome is a specific type of shingles, which is a reactivation of the varicella-zoster virus that causes chickenpox. After a chickenpox infection, the virus lies dormant in a single nerve in the body. Shingles affects whichever spinal nerve or cranial nerve where the virus is dormant. When shingles affects the facial nerve, it is called Ramsay Hunt syndrome.

This article will explain what Ramsay Hunt syndrome is. It will also describe the symptoms, causes, and treatment options of the condition.

What is Ramsay Hunt syndrome?

man with half of face covered
Martinez/Stocksy United

Ramsay Hunt syndrome, also known as herpes zoster oticus, is a complication of the chickenpox virus that can occur later in life. The varicella-zoster virus causes chickenpox in children and shingles in adults and can lie dormant in the body until it reactivates.

Many people get chickenpox as children. The virus over the years may continue to live in one of your nerves and is harmless until it reactivates.

Who gets it?

Ramsay Hunt syndrome affects about 5 in every 100,000 people per year. It accounts for 7% of facial paralysis cases. Although it can present in any one of any age, those in their 70s or 80s are more likely to receive a diagnosis.

Read more about chickenpox and shingles here.

Ramsay Hunt syndrome vs. Bell’s palsy

Bell’s palsy is the most common type of facial paralysis. The cause of it is unknown, but it may look similar to Ramsay Hunt syndrome, and it is often clinically difficult to differentiate between the two.

A major difference is that Ramsay Hunt syndrome usually causes a rash along with facial weakness, but Bell’s palsy does not cause any changes in the skin.

With Ramsay Hunt syndrome, around 70% regain usual or near-usual facial function, whereas with Bell’s palsy it is much higher, with around 90% gaining full function of their facial muscles again.

In general, the outlook for people with Bell’s palsy is better than for those with Ramsay Hunt syndrome.

What are the symptoms of Ramsay Hunt syndrome?

The symptoms of Ramsay Hunt syndrome can vary for each person. Facial paralysis, the most common symptom, usually only appears on one side of the face.

Symptoms include:

  • paralysis or palsy of the face, usually on one side of the face
  • difficulty closing an eye or blinking on the affected side
  • blistered rash from ear to ear
  • weak or stiff facial muscles
  • slurred speech
  • inability to make facial expressions such as smiling or frowning
  • painful blisters in the mouth
  • sound of ringing in the ear
  • ear pain
  • loss of hearing
  • nausea
  • episodes of vomiting
  • vertigo

When should you contact a doctor?

If you notice symptoms such as facial paralysis or a rash on the face, get immediate medical care. Prompt diagnosis and treatment are important to avoid any complications from Ramsay Hunt syndrome.

What causes Ramsay Hunt syndrome?

The varicella-zoster virus causes shingles, including the Ramsay Hunt syndrome variant. It is the same virus that causes chickenpox and can remain dormant in the body for decades until it reactivates.

What causes it to reactivate?

The varicella-zoster virus may reactivate due to a number of reasons, including:

  • low immune system, unable to fight off infection
  • stress
  • reexposure to the virus
  • age
  • post-pregnancy
  • menopausal hormonal changes
  • chemotherapy

How do you treat Ramsay Hunt syndrome?

The main goal of treatment for Ramsay Hunt syndrome is to manage and heal the complications that arise, such as facial paralysis, synkinesis which is unwanted facial contractions, and pain, known as postherpetic neuralgia.

Starting prompt treatment within 3 days of the beginning of symptoms can lead to better results.

Treatments can include:

  • antiviral medications
  • steroids
  • artificial tears or eye drops to help with eye issues related to facial paralysis
  • pain relief medications
  • anti-inflammatory medications
  • antihistamines for vertigo
  • massage therapy

How do you diagnose Ramsay Hunt syndrome?

Healthcare professionals usually diagnose through a thorough clinical evaluation such as looking at past medical history, including if you had chickenpox as a child, and identifying characteristics such as facial paralysis and a rash. However, this can sometimes be difficult because not all symptoms will happen at the same time.

The most important aspect of diagnosis is ruling out a stroke.

Diagnosis can include:

  • viral studies to detect the varicella-zoster virus in the body, through blood, tears, and saliva
  • facial nerve function tests
  • tests to determine hearing
  • MRI to detect inflammation in the facial nerves

What are some complications of Ramsay Hunt syndrome?

People with preexisting conditions may take longer to respond to treatment for Ramsay Hunt syndrome, with an overall longer recovery process.

The preexisting conditions can include:

Complications related to Ramsay Hunt syndrome can include:

  • pain, known as postherpetic neuralgia
  • synkinesis, which is unwanted facial contractions when attempting facial movement
  • rash
  • facial paralysis
  • loss of hearing
  • vertigo
  • eye issues
  • depression and social anxiety, particularly due to loss of facial function

People more than 50 years old usually have more complications with facial paralysis.

How can you prevent Ramsay Hunt syndrome?

Right now, there is no known way to prevent Ramsay Hunt syndrome. Although, there is a vaccine that can help prevent the viral reactivation of shingles, known as Shingrix.

Read more about the shingles vaccine here.

What is the outlook for those with Ramsay Hunt syndrome?

Recovery is different for each person living with the condition, but usually, almost every person can recover. This depends on the severity of the diagnosis, along with how fast you receive treatment.

If you receive antiviral medication within 72 hours of developing symptoms, then you have a 70% chance of a full recovery.

If it is not within 72 hours, then the chance of recovery reduces to 50%. If the damage to the nerves are mild, recovery should take a couple of weeks.

Summary

Ramsay Hunt syndrome, a type of shingles, occurs when the virus that causes chickenpox reactivates in the facial nerve. The varicella-zoster virus can lie dormant in your nerves for decades after having chickenpox.

Ramsay Hunt syndrome treatment needs to be prompt, within 3 days of noticing symptoms, to ensure a higher chance of recovery. Treatments usually include antiviral medications and steroids.

Recovery can vary for each person living with Ramsay Hunt syndrome, but the more prompt the diagnosis, the quicker the recovery process.

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Medical Reviewer: Heidi Moawad, M.D.
Last Review Date: 2022 Jun 16
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