Diseases & Conditions

Ramsay Hunt syndrome

Ramsay Hunt syndrome is an infection of your facial nerve that's accompanied by a painful rash and facial muscle weakness, among other signs and symptoms.

The cause of Ramsay Hunt syndrome is varicella-zoster virus, the same virus that causes chickenpox. After chickenpox heals, the virus lies dormant in your nerves. Years later, it may reactivate. If the virus reactivates and infects your facial nerve, the result is Ramsay Hunt syndrome.

The onset of Ramsay Hunt syndrome can be frightening. The symptoms may cause some people to fear they're having a stroke. But, there's often effective treatment for Ramsay Hunt syndrome. Sometimes, Ramsay Hunt syndrome can lead to permanent facial muscle weakness and hearing loss. Prompt treatment can reduce your risk of complications.

Signs and symptoms of Ramsay Hunt syndrome include:

• A painful red rash with fluid-filled blisters on your eardrum, external ear canal, the outside of your ear, the roof of your mouth (palate) or your tongue
• Facial weakness (palsy) on the same side as the affected ear
• Difficulty closing one eye
• Ear pain
• Hearing loss
• Ringing in your ears (tinnitus)
• A sensation of spinning or moving (vertigo)
• A change in taste perception or loss of taste

When to see a doctor
If you experience weakness on one side of your face or if you develop a rash in or around your ear or in your mouth along with facial weakness, call your doctor for an urgent evaluation. Ramsay Hunt syndrome isn't a condition that requires emergency care. But, diagnosis and treatment within seven days of the start of signs and symptoms may help prevent long-term complications.

The cause of Ramsay Hunt syndrome is a reactivation of the varicella-zoster virus — the same virus that causes chickenpox.

Varicella-zoster is part of a family of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Many of these viruses can lie hidden in your nervous system after the first infection and remain dormant for years before causing another infection.

If your immune system doesn't destroy all the varicella-zoster virus during the initial infection, the remaining virus may reactivate later and infect your facial nerve — producing Ramsay Hunt syndrome. Reactivation of this virus can also cause other disorders, including shingles (herpes zoster). Researchers don't clearly understand how or why the varicella-zoster virus re-emerges.

Ramsay Hunt syndrome is also called herpes zoster oticus.

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 may take a sample of fluid from one of the rash blisters in your ear and perform a polymerase chain reaction (PCR) test on it. This test can detect the varicella-zoster virus. A PCR test can also be done on a blood or tear sample. But, testing fluid from your ear offers more-reliable results.

Prompt treatment of Ramsay Hunt syndrome can ease pain and decrease your risk of long-term complications. To treat Ramsay Hunt, your doctor may prescribe the following medications:

• Antiviral medication, such as acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex)
• Corticosteroids, such as prednisone, to reduce swelling and pain
• Diazepam (Valium), to relieve vertigo
• Pain relievers

If facial weakness remains after treatment, physical therapy involving facial exercises may help you improve or regain control of your facial muscles.

If you have trouble closing one of your eyes because of facial weakness, your doctor may recommend an injection of botulinum toxin type A (Botox) into your upper eyelid, allowing it to close and protect your eye.

Depending on the extent of damage to your facial nerve, recovery from Ramsay Hunt syndrome can take from several weeks to several months. If damage is severe, or if treatment is delayed, full recovery may not be possible.