Ramsay Hunt Syndrome

What is Ramsay Hunt Syndrome?

Ramsay Hunt Syndrome (herpes zoster oticus) is a rare and painful condition that is caused by the same virus that causes chicken pox and shingles. It can remain dormant in the body for many years before striking the facial nerve. It may look like nothing more than a very bad rash, but it can result in infection and other serious complications.

The infection can cause lasting impairment including facial paralysis, nerve damage, disfigurement and permanent hearing loss. It is not preventable, but the sooner it is treated the less likely that complications will occur.

What are the Symptoms of Ramsay Hunt Syndrome?

The signs of Ramsay Hunt syndrome can vary from one person to the next. Keep in mind that not everyone with herpes zoster oticus develops a visible rash. Symptoms may include:

  • Fluid-filled blisters that form a painful rash on, in or near the ear and within the mouth
  • Decreased hearing on the affected side
  • Ringing in one ear
  • Loss or change in sense of taste
  • Weakness or loss of movement on the affected side of the face
  • One eye may not fully close
  • Food and beverages may run from the affected side of the mouth
  • Problems forming facial expressions
  • Vertigo (room spinning)

Ramsay Hunt Syndrome Causes

Ramsay Hunt Syndrome is caused by the same virus that causes chicken pox and the shingles. It is actually a variation of a shingles outbreak where the virus, varicella zoster, attacks a facial nerve near the ear. It causes a red rash, facial paralysis, and can cause dry mouth, vertigo, and other symptoms of a viral infection. The effects are usually temporary, but Ramsay Hunt Syndrome can cause hearing loss and damage to the eye on the side of the face affected by the virus. Men and women are equally at risk, but it is more likely to occur in people over the age of 60. Ramsay Hunt Syndrome is very rare, affecting only about 5 out of 100,000 people, and only affects people who have had chicken pox at some point. Scientists are not clear why the virus reactivates in some people and not in others.

How is Ramsay Hunt Syndrome Treated?

After Ramsay Hunt syndrome has been diagnosed through a physical exam, blood, nerve and skin tests, imaging, an EMG, and/or a spinal fluid test, treatment may include:

  • Gently washing the rash with mild soap and water
  • Cool moist compresses to relieve the pain
  • Anti-viral medicine
  • Drops for dry eyes
  • Taping the eye shut if it will not completely close
  • Prednisone to bolster anti-viral meds
  • Anti-anxiety medication to alleviate vertigo
  • Over-the-counter or narcotic pain relief medication

Ramsay Hunt Syndrome Prevention

The most effective way to prevent contracting Ramsay Hunt Syndrome is to avoid the chicken pox initially. As more and more children are routinely vaccinated against chicken pox, Ramsay Hunt Syndrome should become even rarer than it is now. Certainly, the chicken pox vaccine is the best first line of defense. For older adults who have already had chicken pox, that is not an option. The shingles vaccine has been shown to help prevent shingles in adults that have had chicken pox or have been exposed to the varicella zoster vaccine. While Ramsay Hunt Syndrome is not contagious, people who are infected with it and have the rash with blisters should avoid contact with newborns, pregnant women or anyone with a compromised immune system as it may be possible to spread the virus, which could cause chicken pox in someone who has not yet been immunized.

Last Reviewed:
October 09, 2016
Last Updated:
December 05, 2017