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Ramsay Hunt Syndrome

(Herpes Zoster Oticus)

Definition

Ramsay Hunt syndrome (RHS) is a disorder from an infection of facial nerves. It can affect the ear, mouth, face, neck, and scalp. It results in a painful rash of the ears or mouth.
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Causes

The varicella zoster virus (VZV) causes RHS. The virus is the same one that causes chickenpox and shingles . It stays in the body even after the illness has passed. In some, it can reactivate and cause RHS.

Risk Factors

Here are some factors that may raise your risk of RHS:
  • Having shingles or a history of chickenpox
  • A weakened immune system
  • Having people in your family who have had shingles

Symptoms

RHS may cause:
  • Painful, one-sided red rash in the ear, mouth, or on the tongue
  • Problems moving one side of your face, with or without a rash— Bell palsy
  • Dry mouth and eyes
  • Loss of taste
  • Hearing loss
  • Ringing in the ear— tinnitus
  • Nausea or vomiting
  • A sensation of spinning while standing still— vertigo
  • Eye movements that you can't control— nystagmus

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. A diagnosis can often be made based on history and physical exam.
Lab tests may need to be done to confirm shingles or find other causes.

Treatment

You may not need treatment if your symptoms are mild. You may need care for moderate or severe symptoms. It can reduce your discomfort and shorten the time you are sick. You may be given:
  • Antiviral medicine—may shorten the length of time of the infection if taken early
  • Corticosteroids—to reduce inflammation around the nerve
  • Benzodiazepines—to reduce vertigo symptoms
  • Pain medicine
You may need treatment for other symptoms. For example, you may need eye care if the infection is making it hard to completely close your eyes.

Prevention

The herpes zoster vaccine may lower the chances of getting shingles, including RHS.
The vaccine is advised for most people aged 50 years and older. It is also advised for people with a weakened immune system. They have a higher risk of getting shingles.

RESOURCES

National Institute of Neurological Diseases and Stroke
http://www.ninds.nih.gov
National Organization for Rare Disorders
https://rarediseases.org

CANADIAN RESOURCES

Canadian Neurological Sciences Federation
http://www.cnsfederation.org
Health Canada
https://www.canada.ca

References

About shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles/about/index.html. Updated October 17, 2017. Accessed June 12, 2018.
Herpes zoster. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113997/Herpes-zoster . Updated February 19, 2018. Accessed June 12, 2018.
Herpes zoster oticus. Genetic and Rare Diseases Information Center. Available at: https://rarediseases.info.nih.gov/gard/7525/herpes-zoster-oticus/case/28741/case-questions. Updated August 19, 2016. Accessed June 12, 2018.
NINDS herpes zoster oticus information page. National Institute of Neurological Diseases and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Herpes-Zoster-Oticus-Information-Page. Updated May 24, 2017. Accessed June 12, 2018.
Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(2):149-154.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 05/2018
  • Update Date: 06/12/2018
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