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What Is Ramsay Hunt Syndrome?

Medically Reviewed by Dan Brennan, MD on June 13, 2022

Ramsay Hunt syndrome (RHS) is a condition that can bring on weakness or paralysis in your face and a rash that affects your ear. Your doctor might also call it herpes zoster oticus.

Anyone who’s had chickenpox can get RHS. But Ramsay Hunt syndrome is rare. About 5 out of every 100,000 people in the U.S. get it each year.

Fast treatment is key. The sooner your doctor gets you medicine for RHS, the better your chances are for a good recovery.

What Causes RHS?

The varicella-zoster virus, the same virus that causes chickenpox and shingles, brings on Ramsay Hunt syndrome.

After you recover from chickenpox as a child, the virus turns “off,” or becomes inactive. But it stays in your body, and it could become active again years and years later. Experts aren’t sure why.

If the virus flares up, it can attack the nerves that affect movement and feeling in your face. It can also set off shingles in adults.

What Are the Risk Factors?

Your chances of getting RHS go up if you’ve had chickenpox.

You’re more likely to get RHS when you’re older, especially over 60. It’s extremely rare for a child to get the condition.

What Are the Symptoms of RHS?

RHS usually causes a painful rash of blisters filled with fluid in or around one ear. In some cases, the 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.

RHS also usually causes some weakness in the muscles in your face. You may find it hard to smile or completely close one eye. You might not be able to move the muscles on one side of your face at all. Some people’s speech becomes slurred, too.

These symptoms usually affect one side of your face. The rash and facial paralysis might not show up at the same time.

Some other symptoms are:

  • Ear pain, which can start before you see a rash
  • Hearing loss
  • Ringing in the ear
  • Vertigo, which can make it feel like you -- or the room around you -- is spinning
  • Nausea and vomiting

Is It Contagious?

You can't get RHS from someone who has it.

But the virus in the RHS blisters is the same virus that causes chickenpox, and it is contagious if someone comes in contact with an open blister. This wouldn't cause RHS, but it could cause you to get chickenpox if you’re not already immune or vaccinated from chickenpox.

How Is RHS Diagnosed?

If you think you may have RHS, see a doctor right away, so you can start treatment quickly if you need it.

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.

What Are the Treatments for RHS?

Antiviral drugs like acyclovir and famciclovir may help you get better faster. It’s important to start treatment as early as possible.

Your doctor may also give you a prescription for pain medication or a corticosteroid to help make you more comfortable and get rid of some of the inflammation.

What Self-Care Tips Can Help?

While your rash is healing:

  • Keep the area clean.
  • Put a cool, wet compress on it to relieve pain.
  • Take an over-the-counter painkiller or anti-inflammatory drug like ibuprofen.

What Should I Know About Recovery and Complications?

Infections usually clear up within a couple of weeks. The facial paralysis and hearing loss linked to RHS tend to be temporary. But it’s possible for these problems to become permanent.

Talk to your doctor about any symptoms you notice during or after treatment.

Some people have nerve pain from RHS after the rash is gone. Your doctor has medicines that can ease it. It’s rare, but some people need surgery to ease pressure on the nerve in their face.

If you feel nauseous and dizzy, medicines can relieve those symptoms, too.

If you have trouble closing your eye due to facial paralysis, your doctor may prescribe artificial tears and lubricating ointments. These help protect the clear outer layer of your eye, called the cornea. The doctor might also have you wear an eye patch at times while your face heals.

What Is RHS Type II?

It’s just another name for herpes zoster oticus and Ramsay Hunt syndrome.

Show Sources

SOURCES:

National Organization for Rare Diseases: “Ramsay Hunt Syndrome.”

ENT Health: “Ramsay Hunt Syndrome.”

Mount Sinai: “Ramsay Hunt Syndrome.”

Neurology: “Ramsay Hunt Syndrome Type II.”

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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