- What Is It?
- Grading Scale
- Prognosis & Complications
Ramsay Hunt syndrome (RHS) is caused by the reactivation of the varicella zoster virus in the facial nerve. In most individuals, the varicella zoster virus may stay dormant by immune system activity. What specifically triggers the reactivation of the virus is not well understood.
Some of the triggers that may play a role include:
- Emotional stress
- Vigorous physical activity
- Older age
- Immune suppression due to an infection such as COVID-19
- Human immunodeficiency virus/Acquired immunodeficiency syndrome
- Organ or bone marrow transplant recipients
Thus, conditions that may compromise or weaken the immune system may trigger RHS. The syndrome occurs more commonly in adults and rarely in children. It affects both men and women equally.
Although there have been occasional cases that report RHS after COVID-19 vaccination, these instances are very rare. Life-saving advantages of COVID-19 vaccines must be taken into consideration before one decides to avoid vaccination due to unnecessary fear of RHS.
What is Ramsay Hunt syndrome?
Ramsay Hunt syndrome (RHS), also called herpes zoster oticus or geniculate ganglion herpes zoster, is a late complication of varicella zoster virus infection.
- Varicella zoster virus causes chickenpox in children.
- Once the chickenpox is cleared from the system, the virus stays inactive in the nerve tissue and may get reactivated under certain situations.
- The reactivation of the varicella zoster virus leads to typical vesicular lesions called shingles anywhere on the body.
- When they involve the facial nerve, the condition is called RHS.
RHS occurs when the previously dormant or inactive varicella zoster virus gets reactivated and causes inflammation of a particular part of the facial nerve called the geniculate ganglion. Fewer than one percent of varicella zoster virus infections result in RHS. The disorder has been named after the American neurologist Dr. James Ramsay Hunt who described this disorder.
Ramsay Hunt syndrome facial nerve grading scale
The House-Brackmann facial nerve grading scale is used to grade the severity of facial nerve involvement in RHS:
|Grade II||Mild dysfunction|
|Grade III||Moderate dysfunction|
|Grade IV||Moderately severe dysfunction|
|Grade V||Severe dysfunction|
|Grade VI||Total paralysis|
Is Ramsay Hunt syndrome contagious?
No, you cannot catch Ramsay Hunt syndrome (RHS) from an affected person. Because the varicella zoster virus causes the syndrome, people not immunized against this virus can catch the infection from a person with RHS through their skin lesions and develop chickenpox.
Vaccination against varicella zoster virus or previous infection by chickenpox thus helps prevent the infection.
What are the symptoms of Ramsay Hunt syndrome?
People affected with Ramsay Hunt syndrome generally report severe pain felt deep within the ear. The pain usually often radiates outward, affecting the pinna of the ear. The onset of pain is usually followed by a rash after several hours or days. The rash appears as small fluid-filled painful blisters or vesicles, affecting about 80 percent of the people diagnosed with the syndrome. Moreover, people report facial weakness that reaches its maximum severity within a week of the onset of symptoms.
Symptoms generally include:
- Vesicular rash that affects the ear or mouth
- Facial weakness and loss of facial expressions on the affected side
- Hearing loss
- Tinnitus (ringing in the ear)
- Ear pain
- Speech difficulty
- Difficulty walking
- Cervical adenopathy (enlarged neck glands)
- Loss of taste
- Dry mouth and eyes
- Difficulty eating and drinking
- Intolerance to sounds
- Chinese Company May Help Ease U.S. Shortage of Cancer Drug
- Opdivo Could Boost Outcomes for People Battling Hodgkin Lymphoma
- More U.S. Kids, Teens Are Getting Weight-Loss Surgeries
- Could a Nitroglycerin Patch Ease Hot Flashes?
- One Form of Menopause Hormone Therapy Might Raise Blood Pressure
- More Health News »
What is the treatment of Ramsay Hunt syndrome?
Treatment of Ramsay Hunt syndrome is mainly focused on relieving the symptoms and minimizing complications. Studies report that early treatment initiation, preferably within three days of symptom onset, gives a better outcome than starting the treatment later.
Treatment generally includes:
- Oral corticosteroids
- Oral antiviral medication (acyclovir and famciclovir)
- Intravenous corticosteroids
- Antihistamines such as meclizine and dimenhydrinate
- Anticholinergic medications (transdermal scopolamine)
- Local anesthetic ear drops
- Pain medications such as ibuprofen, acetaminophen, and opioids
- Transcutaneous electrical nerve stimulation
Your doctor may recommend proper rest to aid recovery. Additionally, they may advise facial rehabilitation exercises. Because there is difficulty closing the eye, special care must be taken to avoid corneal injury. The person is educated about taking care of the eyes. An eye patch, lubricating eye drops, or ointments may be prescribed for the same.
Is Ramsay Hunt syndrome serious?
People with Ramsay Hunt syndrome (RHS) may not recover completely, especially if treatment is not initiated within three days (72 hours) of symptom onset. Generally, fewer than half of the affected people will have a complete recovery.
Certain conditions are associated with a poorer prognosis, which includes:
- Age older than 60 years
- Diabetes mellitus
- High blood pressure
- Complete facial paralysis
Complications of RHS may include:
- Synkinesis (unwanted contractions of the facial muscles during attempted movements)
- Permanent facial paralysis
- Postherpetic neuralgia (persistent nerve pain)
- Hearing loss
- Brainstem encephalitis (inflammation of the brainstem)
- Meningitis (inflammation of the coverings over the brain)
- Other cranial nerve involvement (polycranial neuropathy)
- Myelitis (inflammation of the spinal cord)
Health Solutions From Our Sponsors
Top What Triggers Ramsay Hunt Syndrome Related Articles
Can You Get Shingles After Being Vaccinated?Shingles is a viral infection. It presents with a rash followed by an episode of intense pain in the infected area. This is caused by the virus called varicella zoster. This virus also causes chickenpox. If a child has had chickenpox, the virus may not completely go away, lie dormant in the body and come back years later as shingles. Older individuals and immunocompromised individuals are more likely to develop shingles.
Can You Have a Mild Case of Shingles?The severity of shingles depends on various factors, such as age of the patient, general health condition of the patient, and the part of the body where shingles develops.
Herpes Zoster PictureHerpes zoster. Shingles is cause by herpes zoster which is a reactivation of the varicella zoster virus (VZV). VZV causes chicken pox and stays in your body for the rest of your life. When it reactivates, it results in a red rash that includes blisters and is generally painful and itches. Shingles can last days or even weeks and it can result in scarring and prolonged pain along the nerve affected. The rash usually dries out and becomes crusty. It can result in scarring and prolonged pain along the nerve affected.
How Much Does a Shingles Shot Usually Cost?Depending on your medical insurance plan, the full price for two doses of the shingles vaccine could cost around $324 or less.
Mono (Infectious Mononucleosis)Infectious mononucleosis is a virus infection in which there is an increase of white blood cells that are mononuclear (with a single nucleus) "Mono" and "kissing disease" are popular terms for this very common illness caused by the Epstein-Barr virus (EBV).
Is Shingles Contagious?Shingles is an infection caused by the varicella-zoster virus. Shingles symptoms and signs include skin burning, numbness, and tingling along with a painful red, blistering rash. Shingles is contagious until all of the blisters have crusted over.
Ramsay Hunt SyndromeRamsay Hunt syndrome is an infection of a facial nerve that causes a red painful rash with blisters and facial paralysis. Other symptoms of Ramsay Hunt syndrome may include ear pain, hearing loss, dizziness (or vertigo), dry eye, and changes in taste sensation. The herpes zoster virus causes the infection.
Shingles (Herpes Zoster)Shingles, or herpes zoster, is a painful rash caused by the varicella zoster virus. Other shingles symptoms include headache, fever, nausea, and body aches. Treatment focuses on pain management and shortening the duration of the illness with antiviral medications.
Shingles QuizShingles falls within a well-known family of viruses that cause itching, burning, blisters, and pain. Take the Shingles Quiz to get the facts, causes, symptoms, and treatments for this itchy, painful condition.
What Is the Main Cause of Shingles Rash? Signs, Symptoms, VaccineShingles occurs when the varicella-zoster virus, the same virus that causes chickenpox, re-emerges due to a weakened immune system. Tingling may occur before herpes zoster blisters appear, usually on the side of the body. The shingles vaccine can boost the immune system to lower the risk of shingles outbreaks.
Myths and Facts About ShinglesThere are some common misconceptions about this viral illness and the uncomfortable rash it can cause. Here's a guide through the myths and facts of shingles.
What Does a Shingles Rash Look Like at First?The typical shingles red rash or blisters occur after pain, itching, and tingling. They are usually limited to one side of the face and body.
What Triggers a Shingles Outbreak?Shingles occur when the varicella-zoster virus, the same virus responsible for chickenpox, reactivates in the body, usually due to a weakened immune system. Learn about the symptoms of shingles and how you can treat them. The difference between chickenpox and shingles is that the first time you get infected with the varicella virus, you get chickenpox. Shingles is a condition you can develop if you've already had chickenpox. Learn about the differences between chickenpox and shingles and how these two diseases are connected.
Why You Shouldn't Get the Shingles VaccineShingles activates when your immunity is low, usually with advancing age. But not everyone who is a candidate for the shingles vaccine should take it.