Ramsay Hunt Syndrome

Overview

Ramsay Hunt syndrome is also called herpes zoster oticus. It occurs when the same virus that causes the chickenpox, Varicella zoster, affects the facial nerve.

Common Symptoms

Usually, the following symptoms occur when a person has Ramsay Hunt syndrome:

• First, they develop a single chicken pock or a group of pox or vesicles, right outside the opening of the ear canal, and sometimes inside the ear canal, on the ear itself, or even on the ear drum.
• Second, they experience acute onset facial paralysis on the same side as the outbreak.
• Finally, they experience either hearing loss, dizziness, or a combination of both. These latter symptoms are caused by viral effects on the eighth cranial nerve, the nerve responsible for both hearing and balance.

Occasionally, an individual will experience facial weakness and hearing or dizziness symptoms, without any skin outbreak. This condition is referred to as zoster sin herpete, but is essentially treated in the same way.

The biggest difference between Ramsay Hunt syndrome and Bell’s palsy is that in Ramsay Hunt syndrome, usually the external ear hurts, can develop redness, or is tender when it is touched or manipulated. In Bell’s palsy, while many people have some kind of pain in or around the ear, the pain is not triggered by actual movement or manipulation of the ear.

Ramsay Hunt syndrome arises in an individual who has already had the chickenpox, and simply represents reactivation of the virus, similar to what happens in shingles. It is likely that shingles vaccination will decrease the likelihood of people developing Ramsay Hunt syndrome, though this has yet to be proven.

Treatment Options

Ramsay Hunt syndrome is treated with both steroids and antiviral medications, similar to Bell's palsy, but usually is somewhat more severe and it takes longer for the facial paralysis to recover. In extremely rare cases, people do not experience meaningful recovery, and require facial reanimation procedures to bring back facial movement.

Much more commonly, people recover, but to an over-recovered state where the face is too tight, and they require the same types of interventions that people with Bell’s palsy do. Physical therapy, Botox injections, selective neurectomy, and minor office procedures can be very effective at resolving these symptoms.