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What is Ramsay Hunt Syndrome?

By Emma Lloyd
Updated May 17, 2024
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Ramsay Hunt syndrome is a type of facial paralysis that can occur in people with an active outbreak of a particular type of herpes simplex virus. This virus, called the herpes zoster virus, also causes chickenpox and shingles. Ramsay Hunt syndrome causes a range of symptoms relating to the function of the ears and facial nerves. In most cases symptoms can be treated with antiviral agents and steroids. This syndrome is associated exclusively with varicella-zoster virus infection.

The symptoms of Ramsay Hunt syndrome are after-effects of infection with herpes simplex virus type 3, also known as varicella-zoster virus. The classic side effects of the syndrome include vertigo, hearing loss, tinnitus, and partial paralysis of facial muscles. Other symptoms may include dryness of the eyes and mouth, partial loss of taste, and a rash in the mouth or ear canal.

Symptoms of the syndrome occur when the varicella-zoster virus infects facial nerves that lie near the inner ear. These nerves are called the geniculate ganglia, and are partially responsible for sensation and movement in the face, ear, ear canal, tongue, eyes and mouth. While the classic form of this syndrome typically includes a rash, a similar condition exists in which the rash does not commonly appear. This is Bell’s palsy, the most common symptom of which is weakness of the facial muscles.

Ramsay Hunt syndrome is typically treated with a combination of medications to reduce pain and inflammation, and prevent symptoms worsening. It should be noted that due to the involvement of a herpes type virus, there is no permanent way to prevent the syndrome. Herpes viruses cannot be entirely eliminated from the body, as they are able to enter periods of latency in the nervous system. Each time a person with the virus experiences an outbreak of active infection, they are at risk of developing symptoms of the syndrome.

Symptoms of Ramsay Hunt syndrome are most often treated with medication. Oral corticosteroids are used to try and reduce the severity of inflammation, but because steroids dampen the immune response the use of these may be avoided during periods of active viral infection. During such times, oral antiviral agents such as acyclovir are administered to reduce the severity of symptoms and limit the period of active viral infection.

While it is not possible to completely prevent the recurrence of an active virus outbreak, it is possible to prevent permanent nerve damage as long as steroid and antiviral treatment is started quickly. If medication can be administered within three days of the onset of paralysis of facial muscles, a patient has a 75% chance of making a full recovery. If treatment is delayed, however, the chance of preventing permanent nerve damage increases sharply.

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