Ramsay Hunt Syndrome

Medically reviewed by Alana Biggers, MD on June 12, 2017Written by Tim Jewell on June 12, 2017

Overview

Ramsay Hunt syndrome happens when shingles affects nerves in your face close to either one of your ears. Shingles affecting either ear is a condition caused by a virus called herpes zoster oticus. The general varicella-zoster virus also causes chicken pox, which is most common in children. If you’ve had chicken pox in your life, the virus can reactivate later in your life and cause shingles.

Both shingles and chicken pox are most recognizable by a rash that appears in the affected area of the body. Unlike chicken pox, 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.

If you get a rash on your face and also start noticing symptoms such as facial muscle weakness, see your doctor as soon as you can. Early treatment can help make sure you don’t experience any complications from Ramsay Hunt syndrome.

Symptoms

The most visible symptoms of Ramsay Hunt syndrome are a shingles rash near one or both ears and abnormal paralysis in the face. With this syndrome, facial paralysis is noticeable on the side of the face that’s affected by the shingles rash. When your face is paralyzed, the muscles may feel harder or impossible to control, as if they’ve lost their strength.

A shingles rash can be spotted by its red, pus-filled blisters. When you have Ramsay Hunt syndrome, the rash may be 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 top of your throat. In other cases, you may not have a visible rash at all, but still have some paralysis in your face.

Other common symptoms of Ramsay Hunt syndrome include:

  • 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
  • a feeling like the room is spinning, also called vertigo
  • slightly slurred speech

Causes and risk factors

Ramsay Hunt syndrome isn’t contagious on its own, but it does mean you have the shingles virus. Exposing someone to the varicella-zoster virus if they haven’t had a previous infection can give them chicken pox or shingles.

Because Ramsay Hunt syndrome is caused by shingles, it has the same causes and risk factors. These include:

  • previously having chicken pox
  • being older than 60 years (it rarely occurs in children)
  • having a weak or compromised immune system

Treatment

The most common treatments for Ramsay Hunt syndrome are medications that treat the virus infection. Your doctor may prescribe famciclovir or acyclovir along with prednisone or other corticosteroid medications or injections.

They may also recommend treatments based on the specific symptoms that you have. Nonsteroidal anti-inflammatory drugs (NSAIDs) or antiseizure medications like carbamazepine can help reduce the pain of Ramsay Hunt syndrome. Antihistamines can help with vertigo symptoms, such as dizziness or feeling like the room is spinning. Eye drops or similar fluids can help keep your eye lubricated and prevent cornea damage.

Home remedies

You can treat a shingles rash at home by keeping the rash clean and using a cold compress to minimize pain. You can also take over-the-counter pain medications, including NSAIDs like ibuprofen.

Complications

If Ramsay Hunt syndrome is treated within three days of the symptoms appearing, you shouldn't have any long-term complications. But if it goes untreated long enough, you may have some permanent weakness of the facial muscles or some loss of hearing.

In some cases, you may not be able to close your affected eye completely. As a result, your eye may get extremely dry. You may also be unable to blink out any objects or matter that gets in your eye. If you don't use any eye drops or lubrication, it’s possible to damage the surface of the eye, called the cornea. Damage can cause constant corneal irritation or permanent (although usually minor) vision loss.

If Ramsay Hunt syndrome damages any of your facial nerves, you might also feel pain, even after you don’t have the condition anymore. This is known as postherpetic neuralgia. The pain happens because the damaged nerves don’t detect sensations correctly and send the wrong signals to your brain.

How it’s diagnosed

Your doctor can use several methods to diagnose you with Ramsay Hunt syndrome:

  • Taking your medical history: For example, if you had chicken pox as a child, a shingles outbreak is likely responsible for a facial rash.
  • Performing a physical examination: For this, your doctor checks your body for any other symptoms and closely examines the area affected by the syndrome to confirm a diagnosis.
  • Asking you questions about any other symptoms: They may ask about what other symptoms you have, such as pain or dizziness.
  • Taking a biopsy (tissue or fluid sample): A sample of the rash and affected area can be sent to a lab to confirm a diagnosis.

Other tests that you doctor might recommend include:

  • blood test to check for the varicella-zoster virus
  • skin test to check for the virus
  • extraction of spinal fluid for examination (also called a lumbar puncture or spinal tap)
  • magnetic resonance imaging (MRI) of your head

Outlook

Ramsay Hunt syndrome has few lasting complications. However, if it goes untreated for too long, you may have some permanent muscle weakness in your face or lose some of your hearing. See your doctor as soon as you notice any combination of symptoms to make sure the condition gets treated quickly.

Vaccines exist for both chicken pox and shingles. Getting children vaccinated when they’re young can help prevent chicken pox outbreaks from ever happening. Getting a shingles vaccination when you’re older than 60 years can help prevent shingles outbreaks as well.

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