What is Ramsay Hunt syndrome? Causes, symptoms, treatment, complications, and prevention

Written by Nicolas Perez Diaz, July 9, 2023

People with Ramsay Hunt syndrome suffer from facial paralysis and a painful rash in or around the ear. This syndrome occurs when the varicella-zoster virus, the one that causes chickenpox and shingles, infects a nerve in the head.

It is named after James Ramsay Hunt, the physician who first discovered it in the early 20th century.

Did Justin Bieber have Ramsay Hunt syndrome? According to mdlimx.com:

“Bieber was also diagnosed with Ramsay Hunt syndrome (or herpes zoster oticus), which can cause facial paralysis and hearing damage. Bieber told his fans in a video that his facial paralysis affected his eye, nostril, and mouth on one side—but that it would get better. Ramsay Hunt syndrome is a complication of shingles.”

Causes of Ramsay Hunt syndrome

Ramsay hunt syndrome is caused by a reaction of the varicella-zoster virus, which, following chickenpox, lays hidden in the nerve tissue. The exact reason for the reactivation is not well understood, but it is thought to be connected to a weakened immune system, stress, or other factors that weaken the body’s capacity to maintain the virus under control.

Is Ramsay Hunt contagious? According to nih.gov: “Ramsay Hunt syndrome is known to be a non-contagious infection.”

Signs and Symptoms

The signs and symptoms of Ramsay Hunt syndrome vary from person to person, but typically include:

  • Facial paralysis

The patient experiences weakness or paralysis on one side of the face. The paralysis might affect the mouth, eye, forehead, and other facial muscles.

  • Ear pain

There is severe pain located in or around the ear. This pain often manifests as a sensation of pressure or fullness within the ear and is commonly characterized as sharp, shooting, or burning in nature.

  • Rash

A rash can develop on the affected side of the face, ear, or in the inside of the mouth. Small, fluid-filled, shingles-like blisters form.

  • Vertigo

A sensation of dizziness, spinning, and loss of balance, even though the ground is still.

  • Other signs and symptoms

Patients may also experience hearing loss, tinnitus (ringing in the ears), an altered sense of taste, dry eye, dry mouth, and the closing of one eye (on the affected side.

Ramsay Hunt Syndrome depiction - image of a man with drooping face and rash in an ear

Image created by medicalvocab.com.

Treatment of Ramsay Hunt syndrome

Treatment options usually include:

  • Antiviral medication

Antiviral drugs, like acyclovir, valacyclovir, or famciclovir, are prescribed to help eliminate the varicella-zoster virus and reduce the severity and duration of the infection.

  • Corticosteroids

Prednisone and other oral corticosteroids help reduce swelling and inflammation. These medications can help with pain relief and stop further nerve damage.

  • Pain management

Ask your pharmacist for an OTC medication for pain. OTC stands for over the counter. OTC drugs are those we can buy without a doctor’s prescription. If you need something stronger, ask your doctor.

  • Eye care

If the eye is affected, lubricating eye drops or ointments may help.


Ramsay Hunt syndrome may lead to complications if it is not appropriately managed or treated:

  • Facial weakness or paralysis

There is a risk of long-lasting or permanent facial weakness or paralysis.

  • Eye complications

If the eye is harmed, complications such as corneal ulcers, infections, or corneal damage may develop, impairing vision.

According to mountsiniai.org:

“If there is not much damage to the nerve, you should get better completely within a few weeks. If damage is more severe, you may not fully recover, even after several months. Overall, your chances of recovery are better if the treatment is started within 3 days after the symptoms begin.”

Prevention of Ramsay Hunt syndrome

Preventing the initial infection of the varicella-zoster virus through vaccination against chickenpox is the best way to reduce the risk. Other preventive measures include:

  • Good hygiene practices

Avoid close contact with individuals who have active shingles lesions,

  • Lifestyle

A well-balanced, healthy diet, regular physical exercise, and plenty of good-quality sleep help maintain a strong immune system, which in turn protects you from viral infections.

  • Prompt treatment of shingles

If you have shingles, receiving immediate medical attention and taking your antiviral medicine according to instructions will help stop the virus from spreading and lower your risk of complications.