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Ramsay Hunt Syndrome: What Is This Rare Condition?

By Dr. Nikita Toshi +2 more

Ramsay Hunt syndrome is a complication caused by the varicella-zoster virus. It affects the facial nerves leading to numbness, facial paralysis and loss of hearing sensation on the affected side. This syndrome is characterised by affected facial nerves near the ears and is atypical of a shingles outbreak. It is a rare disease wherein only 10 out of every 100,000 may develop it every year.

Officially the condition is referred to as herpes zoster oticus and the popular terminology comes from Ramsay Hunt who discovered the illness in 1907. The condition affects both genders equally and is attributed to be the most common reason for atraumatic peripheral facial paralysis.

Why does it occur?

Ramsay Hunt syndrome develops due to the varicella-zoster virus, the same virus responsible for causing chickenpox. Once you have recovered from a chickenpox infection, the virus sometimes continues to linger in your nerves. Years or even decades later, it might somehow become reactivated and can affect your nerves. Since 90% of Chickenpox cases affect younger children, the chances of developing Ramsay Hunt syndrome are uncommon amongst children and affect older adults, especially those over 60.

If treatment is undertaken within 3-4 days of the appearance of symptoms, your chances of complete recovery are higher. However, if treatment is delayed, a part of your facial muscles, as well as your hearing faculties, might be permanently damaged.

Ramsay Hunt syndrome, also known as herpes zoster oticus, is a late complication of varicella-zoster virus infection that results in inflammation of facial nerve causing its palsy. The condition is self-limiting, but treatment is targeted at decreasing the total duration of the illness as well as providing pain relief.

Dr. M.G. Kartheeka, MBBS, MD

Signs and symptoms to look out for

Some people can confuse Ramsay Hunt syndrome with that of Bell’s Palsy because in both conditions the onset of facial paralysis is quite rapid. However, the point where both conditions differ is the onset of painful blisters near the outer ear which indicates the infection of the nerves in that region. To give you a detailed idea about the symptoms by dividing them into two groups:

Telling signs of the condition that either occurs simultaneously or one before the other:

  • Facial weakness and/or weakness on one side of the face, usually the side with the affected ear
  • Fluid-filled blisters in, on and around the ear accompanied by a painful red rash

Other signs that can develop slowly:

  • Hearing loss
  • Numbness in half side of the face
  • Deviation of the smile line
  • Difficulty in holding water in the mouth while rinsing (you may notice drooling from the affected side)
  • Ringing in the ears is referred to as tinnitus
  • Trouble closing the eye located on the side of the paralysed face
  • Spinning or moving sensation
  • Dry mouth and eyes
  • A change or loss of taste

Anti-inflammatory drugs (e.g., steroids) to reduce pain and swelling of the nerves are found to be useful. There is usually a good prognosis when treatment is started within three days of the onset of symptoms. However, some patients may have permanent facial paralysis or hearing loss.

Dr. Ashish Bajaj – M.B.B.S, M.D.


Though Ramsay Hunt syndrome isn’t contagious, a reactivation of the varicella-zoster virus can result in the outbreak of chickenpox in people who have already received the shot for chickenpox or haven’t had it before. The infection can cause complications in people with weak immunity. Take special care of:

  • Newborn babies
  • Pregnant women
  • Anyone with an immune-compromised system
  • Any person who has been vaccinated for chickenpox


If you are not quick to respond to the symptoms of Ramsay Hunt syndrome, it can lead to the following complications, some of which are life-long:

  • Hearing loss and facial muscle weakness which are permanent in most cases
  • As a result of the Ramsay Hunt syndrome, you might find it troubling to close your eyelid. Inability to close the eyelid, damages the cornea which does the function of eye protection. The damage can lead to blurry vision and eye pain.
  • Some people can also become affected by postherpetic neuralgia which is painful and occurs when shingles disrupt the nerve fibres. This creates confusion concerning messages sent by the nerve fibres.

Treatment for Ramsay Hunt syndrome

The best way to recover from Ramsay Hunt syndrome is to act upon the symptoms properly to prevent long-term damage to your nerves. Visit a healthcare provider right away who will advise you to take anti-inflammatory and antiviral medicines as needed. If you experience pain in and around the ear region, you may be prescribed to take painkillers for relief. To protect the cornea of the eye when closing the lid becomes a challenge, you can wear an eye patch. This will prevent corneal abrasion and environmental particulate pollutants from entering the eyes. To keep the eyes moisturised, you can apply eye lubricant such as drops.


It is important to get vaccinated for chickenpox and also stay aware to reduce your risk of exposure to viral infections. Whenever you notice any symptoms resembling facial paralysis, ear pain or hearing loss after recovering from chickenpox, do not delay in seeking prompt treatment from a doctor. With patience and diligent treatment, you may win over the condition.

Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.


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