How to Treat Ramsay Hunt Syndrome

Reviewed on 6/14/2022
Woman with Ramsay Hunt syndrome, which can cause a painful rash
Ramsay Hunt syndrome treatment includes antiviral medications, corticosteroids, pain medication, vertigo suppressants, and corneal injury prevention.

Ramsay Hunt syndrome is a rare neurological disorder characterized by facial nerve paralysis (facial palsy) and a rash that affects the ear or mouth. It is caused by the varicella-zoster virus, the same virus that causes chickenpox and shingles (herpes zoster).

Once a person has had chickenpox, the varicella-zoster virus remains dormant in the body. The virus can be reactivated and spread to affect the facial nerve.

Treatment for Ramsay Hunt syndrome includes: 

  • Antiviral medications
  • Corticosteroids
  • Other medications
  • Prevention of corneal injury 
    • The inability to properly close the eye can expose the cornea to abnormal drying and foreign body irritation
    • Eye patch to protect the eye
    • Artificial tears and lubricating ointments are used to protect the cornea

If the nerve is not too damaged, complete recovery usually happens within a few weeks. For those who have more severe nerve damage, full recovery may not occur. Chances of recovery are improved if treatment begins within three days after symptoms start.

Is Ramsay Hunt Syndrome Serious?

Ramsay Hunt syndrome can be serious. Complications of Ramsay Hunt syndrome may include:

  • Facial disfigurement caused by loss of movement
  • Changes in taste
  • Eye damage (corneal ulcers and infections) that may result in vision loss 
  • Persistent pain (postherpetic neuralgia)
  • Face muscle or eyelid spasm
  • Nerves growing back to the wrong structures causing abnormal reactions to a movement, for example, smiling causes the eye to close
  • The virus can spread to other nerves or to the brain and spinal cord which can cause:

What Are Symptoms of Ramsay Hunt Syndrome?

Symptoms of Ramsay Hunt syndrome can vary. The characteristic symptoms of Ramsay Hunt syndrome include: 

  • Paralysis (palsy) of the facial nerve 
    • Muscle weakness
    • Muscle stiffness
    • Inability to smile, wrinkle the forehead, or close the eye on the affected side
    • Speech may become slurred
  • A rash affecting the ear
    • Rash is reddish, painful, blistering 
    • Affects the outer portion of the ear and often the external ear canal
    • Sometimes the rash and blisters may affect the mouth, soft palate, and top portion of the throat

These symptoms do not always occur at the same time and most of the time, only one side of the face is affected (unilateral).

Additional symptoms of Ramsay Hunt syndrome may include: 

What Are the Types of Ramsay Hunt Syndrome?

There are three types of Ramsay Hunt syndrome. These syndromes are unrelated, other than they were all described by and named for neurologist Dr. James Ramsay Hunt.

  • Ramsay Hunt syndrome type 1 
    • Also called Ramsay Hunt cerebellar syndrome
    • A rare form of cerebellar degeneration which involves epilepsy, progressive problems with muscle control, tremor, and dementia
  • Ramsay Hunt syndrome type 2 
    • The type referred to in this article
    • The reactivation of herpes zoster affects the facial nerve and can cause facial paralysis, ear pain, and rash near the ear 
  • Ramsay Hunt syndrome type 3  
    • Also called Hunt's disease or artisan's palsy
    • Less common 
    • Occupationally induced nerve pain of the deep palmar branch of the ulnar nerve in the arm

What Causes Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is caused by the varicella-zoster virus, the same virus that causes chickenpox and shingles. Once a person has had chickenpox, the varicella-zoster virus remains dormant in the body.

  • The virus can be reactivated to result in shingles and, in some cases, it develops into Ramsay Hunt syndrome. It is not known why the virus reactivates and affects the facial nerve in Ramsay Hunt syndrome.
  • Anyone who has had chickenpox could potentially develop Ramsay Hunt syndrome but most cases occur in adults over age 60 years. 

How Is Ramsay Hunt Syndrome Diagnosed?

Ramsay Hunt syndrome is diagnosed with a patient history, physical examination, and identification of the characteristic symptoms (i.e., facial palsy and rash). 

A diagnosis of Ramsay Hunt syndrome can be difficult because the specific symptoms of the disorder (facial paralysis and distinctive rash) do not always occur at the same time.

Tests may include:

Reviewed on 6/14/2022
Image Source: iStock Images