Mayo Clinic Health Library

Ramsay Hunt syndrome

Updated: 01-08-2011

Definition

Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles infection 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 heals, the virus lies dormant in your nerves. Years later, it may reactivate. If the virus reactivates and affects your facial nerve, the result is Ramsay Hunt syndrome.

High doses of antiviral medications and corticosteroids are used to treat Ramsay Hunt syndrome. Prompt treatment can reduce your risk of complications, which can include permanent facial muscle weakness and deafness.

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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

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

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Causes

Ramsay Hunt syndrome occurs in people who have 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.

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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. 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
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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.
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Preparing for your appointment

You're likely to start by first seeing your family doctor. He or she may refer you to a doctor who specializes in nervous system disorders (neurologist) or to an ear, nose and throat specialist (otolaryngologist).

What you can do
Before your appointment, you may want to write a list of answers to the following questions:

  • What are your symptoms? When did they start?
  • Have you had the sensation that the room is spinning (vertigo)?
  • Has your hearing been affected?
  • Have you noticed a change in your sense of taste?
  • Have you had the chickenpox (varicella) vaccine? When?
  • Have you ever had chickenpox? When?
  • Are you being treated for any chronic health conditions? If so, what treatments are you receiving?
  • Are you pregnant?

What to expect from your doctor
During the physical exam, your doctor will closely examine your face, to check for evidence of one-sided paralysis or a shingles rash on, in or around your ear.

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Tests and diagnosis

Doctors often can identify Ramsay Hunt syndrome based on medical history, a physical exam and the disorder's distinctive signs and symptoms. To confirm the diagnosis, your doctor might take a sample of fluid from one of the rash blisters in your ear for testing.

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Treatments and drugs

Prompt treatment of Ramsay Hunt syndrome can ease pain and decrease your risk of long-term complications. Medications may include:

  • Antiviral drugs. Medications such as acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex) often help combat the chickenpox virus.
  • Corticosteroids. A short regimen of high-dose prednisone appears to boost the effect of antiviral drugs in Ramsay Hunt syndrome.
  • Anti-anxiety medications. Drugs like diazepam (Valium) can help relieve vertigo.
  • Pain relievers. The pain associated with Ramsay Hunt syndrome can be severe. Narcotic drugs — such as those containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Vicodin, Lortab, others) — may be needed.
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Lifestyle and home remedies

The following can help reduce the discomfort of Ramsay Hunt syndrome:

  • Keep areas affected by the rash clean.
  • Apply cool, wet compresses to the rash to ease pain.
  • Take an over-the-counter pain reliever or anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others).

If facial weakness makes it difficult for you to close one of your eyes, take the following steps to protect your vision:

  • Use moisturizing eyedrops throughout the day if your eye becomes dry.
  • At night, apply ointment to the eye and tape your eyelid shut, or wear an eye patch.
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Prevention

Children are now routinely vaccinated against chickenpox, which greatly reduces the chances of them becoming infected with the naturally occurring chickenpox virus. A shingles vaccine for people over 60 also is available.

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