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Ramsay Hunt syndrome

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 3 minutes read

Ramsay Hunt syndrome (herpes zoster oticus) is a type of shingles that affects the facial nerve. This causes a number of symptoms, including weakness or paralysis of one side of the face and one-sided hearing loss. It’s caused by varicella-zoster virus (VZV), and implies that you had chickenpox – most likely as a child – and while that illness has cleared, the virus remains dormant in your nerves until it is reactivated.

It’s important to get checked out, firstly because this can look very much like a stroke, and secondly because prompt treatment can help this improve more quickly.

What are the symptoms?

Similar to the distinctive shingles rash, you may get a crop of tiny blisters called vesicles around or inside the ear, or the area might look quite red and wet, and it may give a painful or burning sensation. Vesicles may appear on the hairline or scalp and the mouth, too.

The facial nerve is the 7th cranial nerve of an important 12 coming from each side of the brain and supplying the head and neck. Each facial nerve controls the muscle movements of one side of the face, so you might you can't blink or close your eye, you can’t smile and you may have a droop on one side.

It also supplies the taste buds, so your sense of taste can be affected and you can get some painful vesicles on your tongue. The ability to make tears and saliva can also be affected.

Your hearing and sense of balance may also be affected on the same side as the facial paralysis, leaving you with dizziness, tinnitus (ringing in the ear) and difficulty hearing.

Bell’s palsy can cause a similar facial droop and weakness on one side, and is likely caused by an infection, possibly herpes. But symptoms are usually less severe than Ramsay Hunt syndrome and there is no rash.

How did I catch it? Can I pass it on?

Most people encounter chickenpox as a child. The virus can reactivate when your immune system is down – this can be from illness, certain medications or even a period of stress. You can’t catch Ramsay Hunt syndrome or shingles, and you can’t give someone else shingles.

If you have open vesicles – blisters or wetness that hasn’t crusted over and dried up – these contain live virus, so you may give chickenpox to those who haven’t had it, such as young children. It’s dangerous for those who are pregnant or immunosuppressed if they haven’t had chickenpox.

Will it get better?

Those who receive treatment within the first 72 hours have a 7 in 10 chance of complete recovery. If antiviral tablets are not given within this timeframe, the chance of recovery goes down to half.

For a mild case, you can expect recovery within a few weeks. It takes longer to recover from more severe bouts.

Your doctor may refer you for tests if your hearing is not improving or difficulty closing your eye persists for more than a couple of weeks.

Occasionally, people suffer long-standing twitching or involuntary facial spasms as the nerve gradually recovers, and Botox injections are sometimes considered to improve this.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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