Ramsay Hunt syndrome (RHS) is a complication of shingles. It is the name given to describe the symptoms of a shingles infection affecting the facial nerve. Shingles is caused by the same virus that causes chickenpox (varicella zoster virus, or VZV). As a result of this infection, the facial nerve becomes inflamed and irritated.
If you develop RHS, you will have had chickenpox as a child but once the spots heal and you recover the virus continues to live in the nerves that it has infected by the virus.
It is harmless unless it is reactivated and should this happen new symptoms will appear. This cluster of symptoms is called RHS.
What causes the shingles virus (VZV) to reactivate?
At times our immune system becomes depressed and is less able to fight off infection. The body then becomes vulnerable to reactivation of the chickenpox virus.
Stress is often a trigger. Many studies have shown that stress can weaken the immune system, and that people under significant stress are more likely to suffer from infections than those who are not.
For this reason, it is believed that stress can be linked to outbreaks of shingles, and thus RHS could result.
What are the symptoms of Ramsay Hunt syndrome?
A rash or blisters in or around the ear, scalp or hair line. The blisters may also appear inside the mouth.
The rash/blisters are often painful with a generalised sensation of burning over the affected area.
Weakness on the affected side of your face which causes the facial muscles to droop.
Difficulty closing the eye or blinking on the affected side.
Altered taste on the affected half of the tongue.
Loss of facial expression on the affected side.
Difficulty eating, drinking and speaking as a result of weakness in the lip and cheek on the affected side.
Ear, face or head pain.
Hearing loss on the affected side
Tinnitis (ringing in the ear) on the affected side.
Can you catch Ramsay Hunt syndrome (RHS) from an infected person?
You cannot catch RHS from an infected person.
People with no immunity to chickenpox can develop chickenpox from contact with the open rash or blister on a person who has RHS.
How is Ramsay Hunt syndrome diagnosed?
Diagnosis of the syndrome is most often made by observing the symptoms described above (red painful rash with ear and or mouth blisters and one-sided facial paralysis).
Also, a PCR test (polymerase chain reaction) can be performed on the fluid from the blisters to demonstrate the viral genetic material, but this test is not done routinely.
Is Ramsay Hunt syndrome contagious?
The syndrome is not contagious; however, the herpes zoster virus that can be found in the blisters of Ramsay Hunt syndrome can be transmitted to other people and cause chickenpox in those who are unvaccinated against chickenpox and who have never had chickenpox.
Individuals with Ramsay Hunt syndrome should avoid contact with newborns, pregnant women, immunodepressed individuals, and people with no history of chickenpox, at least until all the blisters change to scabs.
How does Ramsay Hunt syndrome compare with Bell’s palsy?
Bell’s palsy also is a result of injury to the facial nerve by a viral infection, but the suspected viral cause of Bell’s palsy has not been identified.
Ramsay Hunt syndrome is caused by the Varicella virus (Herpes zoster) that also causes chickenpox and shingles (a painful, blister-producing Herpes zoster reinfection that usually occurs on one side of the body).
There is no red rash associated with Bell’s palsy as there is with Ramsay Hunt syndrome.
Additionally, Ramsay Hunt syndrome is commonly more painful than Bell’s palsy. However, both can cause eyelid and mouth paralysis on one side of the face.
Dyssynergia cerebellaris myoclona is a rare degenerative disease of the nerves characterized by epilepsy, muscle spasms, and gradually increasing tremors.
Like Bell’s palsy, this disease complex mimics many symptoms of Ramsay Hunt syndrome. Some investigators term the disease complex Ramsay Hunt syndrome type 2.
What is the treatment for Ramsay Hunt syndrome?
- Prompt treatment (within three days of onset of symptoms) with antiviral medication.
- Prompt treatment with steroids may also be recommended although research to support the use of steroids in the treatment of RHS is inconclusive.
- Find out more about steroids and antivirals here.
What sort of recovery can be expected?
If antiviral treatment is given within 72 hours of developing symptoms approximately 70% of people will experience a virtually full recovery.
If antiviral medication is not given within this time frame then the likelihood of making a full recovery reduces to 50%.
The more severe the damage, the longer it will take to recover, and the lower the chance that you will completely regain normal function.
If damage to the nerve is mild then recovery should take place within a few weeks.
Recovery follows a similar pattern to Bell’s palsy. However symptoms in RHS tend to be more severe than with Bell’s palsy.