Ramsay Hunt Syndrome: Symptoms, Causes, Treatment, and Recovery

Ramsay Hunt syndrome (herpes zoster oticus) is a shingles outbreak affecting the facial nerve near the ear. Caused by varicella-zoster virus reactivation (same as chickenpox). Rare: ~5/100,000 annually; more common over 60.

Symptoms

• Facial weakness/paralysis on one side
• Severe ear pain (otalgia)
• Vesicular rash in/around ear, tongue, palate
• Hearing loss, tinnitus, vertigo
• Dry eye, taste changes, difficulty closing eye

Diagnosis

Clinical exam + facial nerve testing. MRI if atypical or to rule out stroke/tumor.

Treatment (Start Within 72 Hours for Best Outcomes)

• Antivirals: valacyclovir/famciclovir (7–10 days)
• Corticosteroids: prednisone taper (reduces nerve inflammation)
• Pain management: gabapentin, opioids if severe
• Eye protection: lubricants, taping at night if lid won't close
• Physical therapy: facial neuromuscular retraining

Prognosis

• ~70% recover fully if treated early.
• Risk of permanent facial weakness, synkinesis (involuntary movements), hearing loss.
• Post-herpetic neuralgia possible.

Risk Factors

• Age >60
• Prior chickenpox/shingles
• Immunosuppression

Seek care immediately for facial droop + ear pain/rash. Early treatment preserves function.