Table of Contents
Ramsay Hunt Syndrome (RHS) 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.
What causes Ramsay Hunt Syndrome
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.
Symptoms can also include a painful rash inside the ear canal and outside the ear, at times attacking the tongue and roof of the mouth, according to the Icahn School of Medicine at Mount Sinai.
The condition mainly affects adults. In rare cases, it is seen in children.
What the Symptoms of Ramsay Hunt Syndrome
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
- It can cause facial paralysis and hearing loss in the affected ear.
- Sensation of things spinning
- Weakness on one side of the face that causes difficulty closing one eye, eating (food may fall 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
Ramsay Hunt Syndrome Treatment
Strong anti-inflammatory drugs called steroids are usually 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 and other damage to the eye if the eye does not close completely.
Outlook
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 of Ramsay Hunt Syndrome
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:
- Confusion
- Drowsiness
- Headaches
- Limb weakness
- Nerve pain
If these symptoms occur, a hospital stay may be needed. A spinal tap may help determine whether other areas of the nervous system have been infected.
Prevention of Ramsay Hunt Syndrome
There is no known way to prevent Ramsay Hunt syndrome, but treating it with medicine soon after symptoms develop can improve recovery.
References
Gantz BJ, Roche JP, Redleaf MI, Perry BP, Gubbels SP. Management of Bell’s palsy and Ramsay Hunt syndrome. In: Brackmann DE, Shelton C, Arriaga MA, eds. Otologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2016:chap 27.
Naples JG, Brant JA, Ruckenstein MJ. Infections of the external ear. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 138.