What is Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is a painful rash around the ear, on the face, or on the mouth. It occurs when the varicella-zoster virus infects a nerve in the head.

Causes

The varicella-zoster virus that causes Ramsay Hunt syndrome is the same virus that causes chickenpox and shingles.

In people with this syndrome, the virus is believed to infect the facial nerve near the inner ear. This leads to irritation and swelling of the nerve.

The condition mainly affects adults. In rare cases, it is seen in children.

Symptoms

Symptoms may include:

Severe pain in the ear
Painful rash on the eardrum, ear canal, earlobe, tongue, and roof of the mouth on the side with the affected nerve
Hearing loss on one side
Sensation of things spinning (vertigo)
Weakness on one side of the face that causes difficulty closing one eye, eating (food falls out of the weak corner of the mouth), making expressions, and making fine movements of the face, as well as facial droop and paralysis on one side of the face

Exams and Tests

A health care provider will usually diagnose Ramsay Hunt Syndrome by looking for signs of weakness in the face and a blister-like rash.

Tests may include:

Blood tests for varicella-zoster virus
Electromyography (EMG)
Lumbar puncture (in rare cases)
MRI of the head
Nerve conduction (to determine the amount of damage to the facial nerve)
Skin tests for varicella-zoster virus

Treatment

Strong anti-inflammatory drugs called steroids (such as prednisone) are usually given. Antiviral medicines, such as acyclovir or valacyclovir may be given.

Sometimes strong painkillers are also needed if the pain continues even with steroids. While you have weakness of the face, wear an eye patch to prevent injury to the cornea (corneal abrasion) and other damage to the eye if the eye does not close completely. Some people may use a special eye lubricant at night and artificial tears during the day to prevent the eye from drying out.

If you have dizziness, your provider can advise other medicines.

Outlook (Prognosis)

If there is not much damage to the nerve, you should get better completely within a few weeks. If damage is more severe, you may not fully recover, even after several months.

Overall, your chances of recovery are better if the treatment is started within 3 days after the symptoms begin. When treatment is started within this time, most people make a full recovery. If treatment is delayed for more than 3 days, there is less of a chance of complete recovery. Children are more likely to have a complete recovery than adults.

Possible Complications

Complications of Ramsay Hunt syndrome may include:

Changes in the appearance of the face (disfigurement) from loss of movement
Change in taste
Damage to the eye (corneal ulcers and infections), resulting in a loss of vision
Nerves that grow back to the wrong structures and cause abnormal reactions to a movement -- for example, smiling causes the eye to close
Persistent pain (postherpetic neuralgia)
Spasm of the face muscles or eyelids

Occasionally, the virus may spread to other nerves, or even to the brain and spinal cord. This can cause: