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Ramsay Hunt Syndrome: Symptoms, Causes, & Treatment

Ramsay Hunt syndrome is described as an acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx.

Ramsay Hunt syndrome (RHS) is an unprecedented neurological disorder characterized by way of paralysis of the facial nerve (facial palsy) and a rash affecting the ear or mouth. Ear abnormalities which include ringing within the ears (tinnitus) and listening to loss can also be presented. Ramsay Hunt syndrome is due to the varicella zoster virus (VZV), the same virus that causes chickenpox in youngsters and shingles (herpes zoster) in adults. In cases of Ramsay Hunt syndrome, formerly inactive (dormant) varicella-zoster virus is reactivated and spreads to have an effect on the facial nerve.


Several specific names have been used to denote this sickness in the medical literature often causing confusion. The sickness is called after James Ramsay Hunt, a health practitioner who first described the disorder in 1907. Years ago, more than one ailment bore the designation Ramsay Hunt syndrome. Ramsay-Hunt syndrome is now used to denote the disorder defined on this document. The ailment is likewise occasionally called herpes zoster oticus because of the function ear rash. However, a few physicians use herpes zostic oticus best for the ear rash and Ramsay Hunt syndrome for the mixture of ear rash and facial paralysis.

Ramsay Hunt syndrome (herpes zoster oticus) occurs while a shingles outbreak affects the facial nerve near considered one of your ears. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear.

Ramsay Hunt syndrome is due to the same virus that causes chickenpox. After chickenpox clears up, the virus nonetheless lives on your nerves. Years later, it can reactivate. When it does, it can have an effect on your facial nerves.

Prompt remedy of Ramsay Hunt syndrome can reduce the risk of complications, which may consist of permanent facial muscle weak point and deafness.


Symptoms of Ramsay Hunt syndrome

The symptoms of Ramsay Hunt syndrome range from case to case. Affected individuals typically revel in paralysis (palsy) of the facial nerve and a rash affecting the ear. These signs do now not continually arise concurrently. In most cases, best one facet of the face is affected (unilateral).

Facial muscle tissues stricken by nerve palsy may be susceptible or sense stiff and can result in the incapability of affected individuals to grin, wrinkle the brow or close their eye at the affected side. In some instances, speech may also end up slurred.

Most cases of Ramsay Hunt syndrome have a reddish (erythematous), painful, blistering (vesicular) rash that influences the outer part of the ear (pinna) and often the outside ear canal. In a few instances, the rash, including painful blisters, might also affect the mouth, gentle palate, and most part of the throat. Some people with Ramsay Hunt syndrome may have facial palsy with proof of varicella-zoster virus through checking out (e.G., blood tests), however without the related pores and skin abnormalities. These instances may be referred to as zoster sine herpete.

Additional symptoms affecting the ear include ringing inside the ear (tinnitus) and ear ache (otalgia). In a few instances, ear pain can be extreme. Pain might also spread to have an effect on the neck. Some affected individuals broaden sensorineural hearing loss, a circumstance wherein sound vibrations aren’t nicely transmitted to the mind due to a defect of the inner ear or the auditory nerve, ensuing in hearing loss. Hearing loss is normally brief (transient), however, in uncommon cases it may come to be permanent.

In a few instances, affected people may additionally experience hyperacusis, a condition in which sounds seem louder (regularly dramatically) than normal. This can cause serious pain for affected people.

Additional signs that can be present consist of nausea, vomiting, and a sensation that one’s environment are spinning (vertigo). In uncommon cases, loss of taste, dry mouth, and dry eyes may additionally arise.

The two primary symptoms of Ramsay Hunt syndrome are:

  • A painful red rash with fluid-filled blisters on, in and around one ear
  • Facial weak spot or paralysis on the identical facet as the affected ear

Usually, the rash and the facial paralysis arise at the same time. Sometimes it is easy to appear earlier than the alternative. Other times, the rash by no means happens.

If you’ve got Ramsay Hunt syndrome, you might additionally experience:

  • Ear pain
  • Hearing loss
  • Ringing for your ears (tinnitus)
  • Difficulty closing one eye
  • A sensation of spinning or moving (vertigo)
  • A trade in flavor perception or loss of flavor
  • Dry mouth and eyes

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When to look a doctor

Call your doctor if you experience facial paralysis or a shingles rash to your face. Treatment that begins inside three days of the begin of signs and symptoms may also assist save you long-term complications



Causes of Ramsay Hunt syndrome

Ramsay Hunt syndrome is due to the varicella-zoster virus, which is the identical virus that causes chickenpox and shingles. The virus can continue to be dormant for decades in someone who has had chickenpox as a child. Reactivation of the varicella-zoster virus results in shingles and, in a few instances, develops into Ramsay Hunt syndrome. The purpose why the virus reactivates and impacts the facial nerve in Ramsay Hunt syndrome is unknown.

Ramsay Hunt syndrome takes place in humans who’ve had chickenpox. Once you recover from chickenpox, the virus remains in your body — on occasion reactivating in later years to cause shingles, a painful rash with fluid-stuffed blisters.

Ramsay Hunt syndrome is a shingles outbreak that impacts the facial nerve close to considered one of your ears. It also can causes one-sided facial paralysis and hearing loss.


Affected Populations

Ramsay Hunt syndrome affected women and men in equal numbers. According to 1 estimate, 5 out of every 100,000 human beings increase Ramsay Hunt syndrome every 12 months in the United States. The sickness is the second most common cause of a traumatic peripheral facial paralysis. Some researchers trust cases of Ramsay Hunt syndrome go undiagnosed or misdiagnosed making it difficult to decide the disease’s real frequency inside the standard populace.

Anyone who has had chickenpox can probably develop Ramsay Hunt syndrome. However, most cases have an effect on older adults, especially those over 60. Ramsay Hunt syndrome affecting children is extremely rare.

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Related Disorders

Symptoms of the following issues may be much like the ones of Ramsay Hunt syndrome.

Bell’s palsy is a non-progressive neurological ailment of the facial nerve (seventh cranial nerve). This disease is characterized by the surprising onset of facial paralysis that can be preceded by a moderate fever, pain in the back of the ear at the affected part, a stiff neck, and weak spot and/or stiffness on one side of the face. Paralysis is idea to be as a result of decreased blood supply (ischemia) and compression of the 7th cranial nerve. The actual etiology of Bell’s palsy isn’t recognized. Viral and immune issues are regularly implicated as a cause for this ailment. There can also be an inherited tendency toward growing Bell’s palsy. (For greater facts on this disease, select “Bell’s palsy” as your seek time period inside the Rare Disease Database.)

Acoustic neuroma is a benign tumor of the 8th cranial nerve. This nerve lies within the internal ear canal. Pressure in these nerve consequences in the early signs and symptoms of acoustic neuroma; a ringing sound in the ear (tinnitus), and/or hearing loss may additionally arise. A related compression of the facial nerve (seventh cranial nerve) might also produce muscle weakness; stress at the trigeminal nerve (fifth cranial nerve) may additionally result in facial numbness. The expansion of the tumor into distinct regions may additionally bring about impaired potential to coordinate movement of the arms and legs (ataxia), numbness inside the mouth, slurred speech (dysphagia), and/or hoarseness. (For more statistics on this disease, pick out “acoustic neuroma” as your search term at the Rare Disease Database.)

Trigeminal neuralgia, also referred to as tic douloureux, is a sickness of the 5th cranial nerve (trigeminal nerve) characterized with the aid of attack of intense, stabbing ache affecting the mouth, cheek, nostril, and/or other regions on one facet of the face. The actual cause of trigeminal neuralgia is not fully understood. (For more information in this disorder, pick out “trigeminal neuralgia” as your search term in the Rare Disease Database.)

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Risk factors Ramsay Hunt syndrome

Ramsay Hunt syndrome can arise in everybody who has had chickenpox. It’s common in older adults, commonly affecting humans older than 60. Ramsay Hunt syndrome is rare in kids.


Ramsay Hunt syndrome isn’t contagious. However, reactivation of the varicella-zoster virus can cause chickenpox in people who haven’t formerly had chickenpox or been vaccinated for it. The infection may be critical for people who’ve immune system problems.


Until the rash blisters scab over, avoid bodily contact with:

  • Anyone who’s by no means had chickenpox or who is by no means had the chickenpox vaccine
  • Anyone who has a vulnerable immune machine
  • Newborns
  • Pregnant women


Complications Ramsay Hunt syndrome

Complications of Ramsay Hunt syndrome might also encompass:

  • Permanent hearing loss and facial weakness: For the most people, the hearing loss and facial paralysis associated with Ramsay Hunt syndrome is temporary. However, it can grow to be everlasting.
  • Eye damage: The facial weakness resulting from Ramsay Hunt syndrome might also make it hard with the intention to near your eyelid. When this takes place, the cornea, which protects your eye, can become broken. This harm can cause eye pain and blurred vision.
  • Postherpetic neuralgia: This painful situation happens when a shingles infection damages nerve fibers. The messages sent with the aid of these nerve fibers end up stressed and exaggerated, causing pain which could close long after different signs and symptoms of Ramsay Hunt syndrome have dwindled.


Diagnosis of Ramsay Hunt syndrome

A diagnosis of Ramsay Hunt syndrome is based on thorough medical evaluation, a detailed patient history and identity of function signs and symptoms (i.E. Facial palsy and rash). Viral research can come across varicella-zoster virus in saliva, tears, and blood but are not necessary to set up a diagnosis of Ramsay Hunt syndrome.

The prognosis of Ramsay Hunt syndrome can be tough due to the fact the specific signs and symptoms of the sickness (otalgia, facial paralysis and the extraordinary rash) do now not usually increase at the same time.

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Prevention of Ramsay Hunt syndrome

Children are actually mechanically vaccinated against chickenpox, which significantly reduces the probabilities of turning into inflamed with the chickenpox virus. A shingles vaccine for people age 50 or older additionally is suggested.


Standard Therapies for Ramsay Hunt syndrome

This include the Treatment of Ramsay Hunt syndrome

The treatment of Ramsay Hunt syndrome usually entails antiviral medicinal drugs, like acyclovir or famciclovir, alongside corticosteroids, like prednisone. Most authorities agree that beginning antiviral remedy within 3 days of onset seems to have the finest gain as activate analysis and control appears to improve effects. Despite therapy, a few diplomas of facial paralysis and listening to loss may end up everlasting in some instances.

Further remedy is directed toward particular signs and symptoms which might be apparent in every human. This includes ache remedy, carbamazepine, an anti-seizure medicinal drug which may additionally help lessen neuralgic ache, and vertigo suppressants like antihistamines and anticholinergics.

Individuals with Ramsay Hunt syndrome need to take special care to save you corneal injury due to the fact the incapacity to properly close the eye can divulge the cornea to odd drying and foreign body inflammation. Artificial tears and lubricating ointments may be prescribed to defend the cornea.

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Home remedies for Ramsay Hunt syndrome

You can deal with a shingles rash at home via retaining the rash smooth and using a chilly compress to limit pain. You can also take over the counter ache medicines, which include NSAIDs like ibuprofen.


Investigational Therapies for Ramsay Hunt syndrome

Information on current scientific trials is posted at the this site. All studies receiving U.S. Authorities funding, and a few supported by way of private industry, are posted in this government web page.



Ramsay Hunt syndrome has few lasting headaches. However, if it goes untreated for too long, you may have a few permanent muscle weakness for your face or lose some of your hearing. See your health practitioner as quickly as you note any combination of signs and symptoms to make sure the condition receives handled quick.

Vaccines exist for both fowl pox and shingles. Getting youngsters vaccinated when they’re young can help prevent hen pox outbreaks from ever occurring. Getting a shingles vaccination whilst you’re older than 60 years can assist prevent shingles outbreaks as properly?


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Health Lines is nutritional consultant, as well as a freelance writer in the field of health and fitness. He specializes in physique transformation and contest preparation for all levels of competition.

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