Overview
Ramsay Hunt syndrome (herpes zoster oticus) occurs when the varicella-zoster virus, the same virus that causes chickenpox and shingles, reactivates near the facial nerve. It typically causes weakness or paralysis on one side of the face along with a painful rash or blisters in or around the ear.
Because the affected nerve travels close to the hearing and balance structures, some people also develop ear pain, hearing loss, ringing in the ear, or vertigo. Compared with Bell's palsy, Ramsay Hunt syndrome tends to cause more severe weakness, and recovery can be less complete, so early recognition matters.
Treatment is generally most helpful when started promptly and usually combines antiviral medication with corticosteroids, along with careful eye protection if the eyelid does not close fully. Evaluation also addresses pain, hearing, and balance, and arranges facial rehabilitation when needed.
Symptoms
Typical symptoms include weakness or paralysis of one side of the face and a painful blistering rash on the ear, in the ear canal, or sometimes in the mouth. Ear pain can be significant and may come before the rash.
Hearing loss, ringing in the ear, and vertigo can occur, and the eye on the affected side may not close fully, leading to dryness and irritation. Taste can also be altered.
Living with ramsay hunt syndrome? The next step is a quiet, unhurried conversation.
Causes and risk factors
The cause is reactivation of the varicella-zoster virus in or near the facial nerve. Anyone who has had chickenpox carries the dormant virus.
Risk increases with age and with conditions or medications that weaken the immune system. Vaccination against shingles can lower the risk of zoster-related complications.
How it is diagnosed
Diagnosis is usually based on the combination of facial weakness with the characteristic ear rash and pain. The examination assesses the degree of facial weakness, the eye's ability to close, and hearing and balance.
Audiograms and vestibular testing, when needed, are arranged through referral, and imaging is considered when the diagnosis is unclear or symptoms are atypical. Recognizing the rash helps distinguish it from Bell's palsy.
Treatment options
Care is generally most effective when started early:
- Antiviral medication, ideally begun promptly
- Corticosteroids when appropriate
- Eye protection with lubrication, taping, or a moisture chamber if the eyelid does not close
- Pain management for the often significant discomfort
- Facial physical therapy and neuromuscular retraining during recovery
- Procedures for the eye or facial nerve if weakness does not recover
Norelle Health treats the facial-nerve condition. When hearing loss or vertigo is present, audiograms, hearing evaluation, and vestibular testing are arranged through referral and coordinated with the appropriate specialists.
When to seek care
Seek medical attention promptly for new facial weakness, especially with ear pain or a rash, because earlier treatment may improve outcomes. Protecting the eye is urgent when the eyelid cannot close fully.
Seek immediate care for severe headache, neck stiffness, confusion, or rapidly worsening symptoms, which can indicate a more serious problem.
Clinical references
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who treat ramsay hunt syndrome
Dr. Rakhna Araslanova
MD, FRCSC, FACS
Fellowship-Trained Facial Plastic & Reconstructive Surgeon — Facial Paralysis and Reanimation
Dr. Rakhna Araslanova is a fellowship-trained facial plastic and reconstructive surgeon who leads facial paralysis and reanimation at Norelle Health, with additional expertise in craniofacial reconstruction and aesthetic facial plastic surgery.
- Facial paralysis rehabilitation and surgical reanimation
- Craniofacial reconstruction
- Aesthetic facial plastic surgery
- Rhinoplasty
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(212) 444-8006Frequently Asked Questions
Both cause one-sided facial weakness, but Ramsay Hunt syndrome is caused by the shingles virus and usually includes a painful ear rash and often ear or balance symptoms. It tends to cause more severe weakness, and recovery can be less complete, which is why prompt treatment is emphasized.
When facial weakness prevents full eyelid closure, the eye surface can dry out and become irritated or injured. Lubricating drops or ointment, taping the eye closed at night, and a moisture chamber help protect it until movement returns.
The varicella-zoster virus can spread to people who have not had chickenpox or the vaccine, potentially causing chickenpox. The active rash should be kept covered, and contact with vulnerable people should be limited until lesions crust over.
Treatment with antiviral medication and, when appropriate, corticosteroids is generally more effective when started early, so prompt evaluation of new facial weakness with ear symptoms is important.
Recovery varies. Some people regain most facial movement, while others have lasting weakness or develop synkinesis, in which movements become linked. Facial physical therapy supports recovery, and additional treatments can help if weakness persists.
Yes. Because the facial nerve lies near the hearing and balance structures, some people develop hearing loss, ringing in the ear, or vertigo. Norelle Health treats the facial-nerve condition; when these symptoms occur, audiograms, hearing evaluation, and vestibular testing are arranged through referral and coordinated with the appropriate specialists.
Vaccination against shingles can reduce the risk of zoster and its complications. Discuss whether it is appropriate for you with your clinician.
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