Ramsay Hunt syndrome happens when shingles affects nerves in your face close to either one of your ears. You may need immediate medical care if you have a facial rash and symptoms like facial muscle weakness.

Ramsay Hunt syndrome, or herpes zoster oticus, is when shingles affects either ear. A shingles rash near the facial nerves by your ears can cause other complications, including facial paralysis and ear pain.

When this happens, it’s called Ramsay Hunt syndrome. Early treatment can help ensure you don’t have complications.

You may have Ramsay Hunt syndrome if you have shingles on your face on the inside, outside, or around the ear. In some cases, the rash can also appear in your mouth, especially on the roof of your mouth or the top of your throat. In other cases, you may not have a visible rash but still have some paralysis in your face.

When your face is paralyzed, the muscles may feel harder or impossible to control, as if they’ve lost their strength.

Ramsay Hunt syndrome can cause symptoms that include:

  • facial muscle paralysis on the side of the face affected by the rash
  • pain in your affected ear
  • pain in your neck
  • ringing noise in your ear, also called tinnitus
  • hearing loss
  • trouble closing the eye on the affected side of your face
  • decreased sense of taste
  • vertigo, or feeling like the room is spinning
  • slightly slurred speech

Learn more about shingles on the face.

Ramsay Hunt syndrome happens when shingles causes inflammation in one of your cranial nerves.

You can only develop shingles and Ramsay Hunt syndrome if you’ve previously had exposure to chickenpox. Shingles occurs when the virus that causes chickenpox, the varicella-zoster virus (VZV), reactivates in your body. This typically happens when your immune system weakens, such as due to:

  • aging
  • illness
  • stress

Treatment for Ramsay Hunt syndrome usually involves antiviral medications in combination with a high dose of corticosteroids, such as prednisone.

Doctors may also recommend additional treatments based on the specific symptoms you have. This can include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs) or antiseizure medications to reduce pain
  • antihistamines to help with vertigo symptoms
  • eye drops to help keep your eye lubricated and prevent cornea damage

Learn more about treatment and home remedies for shingles.

Ramsay Hunt syndrome can cause complications, such as long-term facial weakness, paralysis, or uncontrolled movements. Long-term complications are more likely in people who experience severe facial paralysis.

If facial paralysis affects your ability to blink or close your eye, you can develop damage to the cornea, or the surface of the eye. This can result in irritation or vision loss.

People with Ramsay Hunt syndrome can also have long-term pain after recovering from shingles due to postherpetic neuralgia. This happens when nerves become damaged.

Getting treatment within 3 days of developing symptoms can lower the severity of your symptoms and help prevent complications.

A doctor typically diagnoses Ramsay Hunt syndrome after carrying out a physical exam and taking your medical history. They may also perform other tests if the cause of your symptoms is not clear or to determine the extent of your nerve damage. These can include:

  • a biopsy or fluid sample from the rash
  • a blood test
  • imaging tests, such as an MRI
  • electrodiagnostic testing to create images of your nerves

Many people with Ramsay Hunt syndrome usually recover from the syndrome. But some people may have permanent muscle weakness in the face, hearing loss, or vision loss. This is more likely if you have a severe infection.

It’s best to get immediate medical attention if think you may have Ramsay Hunt syndrome, as early treatment can help you recover faster.

How long does Ramsay Hunt syndrome last?

Many people recover from Ramsay Hunt syndrome when they recover from shingles. But if you experience nerve damage, you may continue to have some symptoms of Ramsay Hunt syndrome after recovery. Some people may continue to have symptoms for a year or more.

Why do people get Ramsay Hunt syndrome?

People can get Ramsay Hunt syndrome when shingles affects specific cranial nerves.

How contagious is Ramsay Hunt syndrome?

Ramsay Hunt syndrome does not usually spread to other people. But if you haven’t had chickenpox, you can get chickenpox from the blisters of someone with Ramsay Hunt syndrome.

Is Ramsay Hunt syndrome caused by stress?

Ramsay Hunt syndrome happens when the virus that causes shingles reactivates in the body. Stress or a weakened immune system can cause shingles to reactivate. Learn more about what causes shingles to reactivate.