Symptoms and causes

Symptoms

The two main signs of Ramsay Hunt syndrome are:

  • A painful red rash with fluid-filled blisters on, in and around one ear
  • Facial weakness or paralysis on the same side as the affected ear

Usually, the rash and the facial paralysis develop at the same time. But in some cases, the rash will occur before the facial paralysis or the paralysis before the rash. Sometimes the rash never materializes.

If you have Ramsay Hunt syndrome, you might also experience:

  • Ear pain
  • Hearing loss
  • Ringing in your ears (tinnitus)
  • Difficulty closing one eye
  • A sensation of spinning or moving (vertigo)
  • A change in taste perception or loss of taste
  • Dry mouth and eyes

When to see a doctor

Call your doctor if you experience facial paralysis or a shingles rash on your face. Treatment beginning within three days of the start of signs and symptoms may help prevent long-term complications.

Causes

Ramsay Hunt syndrome occurs in people who've had chickenpox. Once you recover from chickenpox, that virus can lie dormant in your body for years — sometimes reactivating in later years to cause shingles, a painful rash with fluid-filled blisters.

Ramsay Hunt syndrome is a shingles outbreak that affects the facial nerve near one of your ears. It typically also causes varying degrees of one-sided facial paralysis and hearing loss.

Risk factors

Anyone who has had chickenpox can develop Ramsay Hunt syndrome. But it's more common in older adults, typically affecting people older than 60. (4) Ramsay Hunt syndrome is rare in children.

Ramsay Hunt syndrome isn't contagious. However, reactivation of the varicella-zoster virus can cause chickenpox in people you come in contact with if they haven't previously had chickenpox or been vaccinated for chickenpox. The infection can be serious for people with immune system deficiencies.

Until the rash blisters scab over, avoid physical contact with:

  • Anyone who's never had chickenpox or vaccination for chickenpox
  • Anyone who has a weak immune system
  • Newborns
  • Pregnant women

Complications

Complications of Ramsay Hunt syndrome may include:

  • Permanent hearing loss and facial weakness. For most people, the hearing loss and facial paralysis associated with Ramsay Hunt syndrome is temporary. However, it can become permanent for some people.
  • Eye damage. The facial weakness caused by Ramsay Hunt syndrome may make it difficult for you to close your eyelid. Incomplete eyelid closure can lead to damage of the protective dome of clear tissue over the front of your eye (cornea). This damage can cause eye pain and blurred vision.
  • Postherpetic neuralgia. This painful condition occurs when a shingles infection damages nerve fibers. The messages sent by these nerve fibers become confused and exaggerated — causing pain that may persist long after other signs and symptoms of Ramsay Hunt syndrome have faded.
Nov. 01, 2016
References
  1. Kumar Swain S, et al. Management of Ramsay Hunt syndrome among HIV patients: Our experience in a tertiary care hospital of eastern India. Polish Annals of Medicine. 2016;23:92.
  2. Albrecht MA. Clinical manifestations of varicella-zoster virus infection: Herpes zoster. http://www.uptodate.com/home. Accessed July 22, 2016.
  3. Herpes zoster oticus information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/ramsay2/ramsay2.htm. Accessed July 22, 2016.
  4. Shingles (herpes zoster). Centers for Disease Control and Prevention. http://www.cdc.gov/shingles/index.html. Accessed July 22, 2016.
  5. Herpes zoster oticus. Merck Manual Professional Version. http://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/herpes-zoster-oticus. Accessed July 22, 2016.