What Is Herpes Zoster Oticus?

Medically Reviewed by Jennifer Robinson, MD on June 22, 2020


Herpes zoster oticus is a rare type of shingles -- a viral infection of a nerve that causes a painful rash on the face including the ear. It's caused by the varicella-zoster virus, the same virus that causes chickenpox.

In cases when herpes zoster oticus also causes muscles of the face to become paralyzed, it is called Ramsay Hunt syndrome (RHS).

Anyone who's had chickenpox can get it, but it commonly affects people over 60.


RHS often causes a painful rash of blisters filled with fluid in or around one ear. In some cases, blisters also can show up in your mouth and throat. Regular shingles also cause a blistery rash, but the bumps usually break out on a smallish strip of your torso instead of on your face.

Because of the nerve that is affected, RHS also usually causes some weakness in the muscles in your face. You might find it hard to smile or completely close one eye. In rare cases, you might not be able to move the muscles on one side of your face at all

Other common symptoms include:

  • Ear pain which can start before you see a rash.
  • Hearing loss
  • Ringing in the ear
  • Vertigo
  • Nausea/vomiting


The virus that causes chickenpox (varicella-zoster) hibernates inside groups of nerves. It can stay there forever and never cause trouble again -- or it can "wake up" and create a new infection in one of the nerves in your body. When it affects the nerve in your face that goes to your ear, it's called herpes zoster oticus.

In most cases, there doesn't seem to be a reason for the "reactivation" of the virus. Unlike with chickenpox, people who get shingles can get it again.

Is It Contagious?

You can't get RHS from someone who has it. But the blisters have the live varicella zoster virus in them. So newborns and people who haven't had chickenpox or been vaccinated against it can get chickenpox from someone with RHS.

Diagnosis and Treatment

If you think you may have RHS, you should see a doctor right away so you can begin treatment quickly. Your doctor can usually diagnose it by asking you about your symptoms and doing an exam. But they may want to test a bit of fluid from a blister to confirm it.

If started early, antiviral drugs, like acyclovir, may help you get better faster. Your doctor also may give you a prescription for pain medication or a corticosteroid to help make you more comfortable and get rid of some of the inflammation.

Infections usually clear up within a couple of weeks. Some people have nerve pain from RHS after the rash is gone. In rare cases, surgery is needed to ease pressure on the nerve in your face.

WebMD Medical Reference


Cleveland Clinic: "Herpes Zoster Oticus."

Facial Palsy UK: "Ramsay Hunt Syndrome."

Mayo Clinic: "Ramsay Hunt syndrome," "Shingles."

Merck Manual: "Herpes Zoster Oticus," "Shingles."

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