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Ramsay Hunt Syndrome: Symptoms & causes of shingles in ear

Last update on Nov, 02, 2023

While a rare condition, anyone who has had chickenpox can develop Ramsay Hunt syndrome later in life. Learn all about this condition, including the symptoms, treatment and long-term outlook.

What is Ramsay Hunt Syndrome?

You might already be familiar with shingles, the painful rash that occurs when a nerve and the skin around it are infected by reactivated chickenpox virus (varicella-zoster virus). Ramsay Hunt syndrome is an outbreak of shingles limited to the facial nerves near your ears.

Shingles (herpes zoster) affects approximately 1 out of every 3 people in the United States. Ramsay Hunt syndrome is much more uncommon, and the effects can be particularly uncomfortable due to the location on the face. If not treated quickly, Ramsay Hunt syndrome can result in issues with hearing, balance and speech, the latter due to facial paralysis.

Anyone who has had chickenpox is susceptible to developing shingles or Ramsay Hunt syndrome because the virus lives in the body and can remain dormant for many years.

What are Ramsay Hunt Syndrome symptoms?

The primary Ramsay Hunt syndrome symptoms are facial paralysis and a rash affecting the ear. The severity of the symptoms can vary by person, but the onset is typically sudden and presents similarly to Bell’s palsy, a more common condition that also causes facial paralysis.

However, Ramsay Hunt syndrome is distinct because it is accompanied by a blistering rash in the ear, hearing loss and pain when the ear is touched. Additional symptoms include:

  • Difficulty closing one eye
  • Tinnitus
  • Vertigo
  • Loss of taste
  • Dry mouth and eyes

What causes Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is caused by a reactivation of the chickenpox or varicella-zoster virus. When the virus reactivates, it attacks and infects the facial nerve nearest to the inner ear.

Reactivation of the virus is often the result of a weakened immune system. This can happen naturally with age or stress. It can also be a result of treatments or medications taken for other conditions that have the side effect of weakening your immune system. 

The most prominent Ramsay Hunt syndrome risk factors are age and weakened immunity. Ramsay Hunt is most common in adults over 60 and very rare in children. While you cannot get Ramsay Hunt Syndrome if you have not had chickenpox, if you are exposed to someone with shingles at the blister stage, you could catch chickenpox and have the virus introduced into your system. It could then reactivate in the future.

Ramsay Hunt syndrome is a rare disease. Only about 5 out of 100,000 people are diagnosed with Ramsay Hunt syndrome each year. For comparison, Bell’s palsy is a more common cause of facial paralysis, with about 15-30 per 100,000 people affected per year. 

Ramsay Hunt syndrome is not contagious. However, the varicella-zoster virus that causes it is contagious and can lead to chickenpox in people who have never had the disease and have not been vaccinated. Until any blisters or rashes have healed, it is important to avoid contact with others, especially newborns, pregnant women and anyone with a weakened immune system who might be susceptible to chickenpox.
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How is Ramsay Hunt Syndrome diagnosed?

It is imperative to be seen by a healthcare provider if you have symptoms of Ramsay Hunt syndrome. Delaying treatment, even in a matter of days, can result in permanent complications. A thorough exam might include neurological tests, blood tests and imaging to rule out other causes. Only a qualified healthcare provider can give you a Ramsay Hunt syndrome diagnosis.

Ramsay Hunt Syndrome treatment

Ramsay Hunt syndrome treatment typically includes a high-dose steroid and antiviral medication. Patients might also be prescribed eye drops and ointments for the rash, and other treatment options might be explored based on the individual’s needs. Additional treatments could include:

  • Pain relievers
  • Medication to relieve vertigo
  • Anti-seizure medication

Home remedies such as cold compresses can also help relieve some discomfort.

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What is the recovery time for Ramsay Hunt Syndrome?

Most people recover fully, but Ramsay Hunt syndrome recovery time and degree can vary by person, lasting from weeks to months. Better results can correlate to early treatment, which is why patients need to be treated as soon as symptoms occur.

Ramsay Hunt syndrome can recur, because the virus remains in the body forever, but it is very rare. 

The symptoms are often temporary, but complications from Ramsay Hunt syndrome can occur. Potential complications include:

  • Permanent hearing loss
  • Permanent facial paralysis or weakness
  • Eye damage and blurred or lost vision
  • Postherpetic neuralgia (pain caused by nerve fiber damage)
  • Facial spasms

One of the best ways to reduce the chances of getting Ramsay Hunt syndrome later in life is to receive the chickenpox vaccine as a child. Adults over 50 can also get a shingles vaccine to reduce the risk of getting Ramsay Hunt syndrome. While a vaccine cannot guarantee that you will avoid Ramsay Hunt syndrome, it can greatly reduce your risk.
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