Overview

Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles outbreak affects the facial nerve near one of your ears. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear.

Ramsay Hunt syndrome is caused by the same virus that causes chickenpox. After chickenpox clears up, the virus still lives in your nerves. Years later, it may reactivate. When it does, it can affect your facial nerves.

Prompt treatment of Ramsay Hunt syndrome can reduce the risk of complications, which can include permanent facial muscle weakness and deafness.

Symptoms

The two main signs and symptoms 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 occur at the same time. Sometimes one can happen before the other. Other times, the rash never occurs.

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 that starts 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, the virus stays in your body — 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 can also causes one-sided facial paralysis and hearing loss.

Risk factors

Ramsay Hunt syndrome can occur in anyone who has had chickenpox. It's more common in older adults, typically affecting people older than 60. 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 who haven't previously had chickenpox or been vaccinated for it. The infection can be serious for people who have immune system problems.

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

  • Anyone who's never had chickenpox or who's never had the chickenpox vaccine
  • 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.
  • Eye damage. The facial weakness caused by Ramsay Hunt syndrome may make it difficult for you to close your eyelid. When this happens, the cornea, which protects your eye, can become damaged. 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 last long after other signs and symptoms of Ramsay Hunt syndrome have faded.

Prevention

Children are now routinely vaccinated against chickenpox, which greatly reduces the chances of becoming infected with the chickenpox virus. A shingles vaccine for people age 50 or older also is recommended.

Oct. 01, 2019
  1. Simon RP, et al. Sensory disorders. In: Clinical Neurology. 10th ed. McGraw-Hill Education; 2018.
  2. Herpes zoster oticus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/herpes-zoster-oticus. Accessed August 19, 2019.
  3. Albrecht MA. Treatment of herpes zoster in the immunocompetent host. https://www.uptodate.com/contents/search. Accessed August 25, 2019.
  4. Albrecht MA. Epidemiology, clinical manifestations, and diagnosis of herpes zoster. https://www.uptodate.com/contents/search. Accessed August 25, 2019.
  5. AskMayoExpert. Herpes zoster (shingles). Mayo Foundation for Medical Education and Research; 2019.
  6. Teresa MO. Medical management of acute facial paralysis. Otolaryngology Clinics of North America. 2018; doi.org/10.1016/j.otc.2018.07.004.