Ramsay Hunt Syndrome

Ramsay Hunt syndrome, or herpes zoster oticus, occurs when the varicella-zoster virus reactivates and spreads to the facial nerves near your inner ear. The varicella-zoster virus is the same virus that causes chickenpox and shingles (herpes zoster). Treatment for the condition may include medications including antivirals and corticosteroids.

Other Names of Ramsay Hunt Syndrome

  • Herpes zoster oticus

  • Ramsay Hunt syndrome type 2.

Causes of Ramsay Hunt Syndrome

  • Ramsay Hunt syndrome occurs when the varicella-zoster virus reactivates in the facial nerve, which is the cranial nerve that affects your face, tongue and inner ear.

  • The varicella-zoster virus is the same virus that causes chickenpox and shingles.

  • If you had chickenpox as a child, the virus can remain inactive (dormant) in your nerves for years.

  • Shingles occurs when the previously dormant varicella-zoster virus reactivates.

  • The virus travels down your nerve fibers into your skin, causing painful sores.

  • The virus sometimes develops into Ramsay Hunt syndrome, affecting your facial nerve.

  • Researchers aren’t sure why the virus sometimes involves the facial nerve.

Symptoms of Ramsay Hunt Syndrome

  • Painful rash on your eardrum, ear canal and earlobe.

  • Fluid-filled blisters in your ear canal and on the outside of your ear.

  • Rash on your tongue, throat and roof of your mouth on the affected side.

  • Severe ear pain.

  • Ringing in your ear (tinnitus).

  • Increased sensitivity to sounds (hyperacusis).

  • Hearing loss on one side.

  • Dry eyes and mouth.

  • Hoarseness.

  • Loss of sense of taste.

  • Social anxiety because of facial abnormalities.

Diagnosis of Ramsay Hunt Syndrome

  • Your healthcare provider will perform a physical exam to diagnose Ramsay Hunt syndrome.

  • They’ll ask you about your medical history and symptoms.

  • Your provider will look for a rash and signs of weakness in your face.

  • Diagnosis can be difficult because the symptoms of the condition don’t always develop at the same time.

  • Therefore, your provider may request a laboratory test to confirm the diagnosis.

  • They may collect a sample of your saliva, blood or fluid from a blister.

  • A pathologist will examine the sample under a microscope, looking for the varicella-zoster virus.

  • It isn’t necessary, but your provider may also request an imaging test called a magnetic resonance imaging (MRI) scan.

  • This test can give your provider proof that another condition or disorder isn’t causing your symptoms.

Treatment of Ramsay Hunt Syndrome

  • An antiviral medication to treat the infection or decrease symptoms, such as acyclovir or valacyclovir.

  • A corticosteroid to reduce inflammation of the nerve, such as prednisone.

  • A pain reliever to reduce pain.

  • A variety of possible medications to relieve symptoms of vertigo.

  • An anti-seizure medicine, such as carbamazepine, to treat persistent pain (postherpetic neuralgia).

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