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.
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.
Living with ramsay hunt syndrome? The next step is a quiet, unhurried conversation.
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.
Hearing tests may be used, 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
Management of hearing loss and vertigo is added when those symptoms are present.
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.
Living with ramsay hunt syndrome? The next step is a quiet, unhurried conversation.
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.
Common Symptoms
Living with ramsay hunt syndrome? The next step is a quiet, unhurried conversation.
Treatment Approach
Treatment for ramsay hunt syndrome is individualized based on the severity of symptoms, anatomical considerations, and patient goals. Our specialists may consider:
- 01Prompt antiviral medication
- 02Corticosteroids when appropriate
- 03Eye protection with lubrication and taping when eyelid closure is incomplete
- 04Pain management
- 05Facial physical therapy and retraining during recovery
- 06Procedures for the eye or facial nerve if weakness persists
Specialists who treat ramsay hunt syndrome
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(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. These symptoms are evaluated and managed as part of care.
Vaccination against shingles can reduce the risk of zoster and its complications. Discuss whether it is appropriate for you with your clinician.
Related Procedures
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