PATIENT EDUCATION

Ramsay Hunt Syndrome

Elsevier Patient Education © 2024 Elsevier Inc..
Last revised: February 28, 2024.

Ramsay Hunt syndrome (RHS) is a rare neurologic disorder that affects the nerves in the face and the nerves near the inner ear. This is
caused by the varicella-zoster virus. This is the same virus that causes chickenpox and shingles.

After a person has chickenpox, this virus may become inactive. Years later, the virus can become active again and cause Ramsay Hunt
syndrome. The trigger may be something that weakens the body's defense system (immune system), such as stress.

When the varicella-zoster virus becomes activated, it moves up the facial nerve causing paralysis (palsy) and a painful rash in or around
the ear canal. It may also travel up the nerve that is responsible for hearing. Ramsay Hunt syndrome cannot be passed from person to
person (is not contagious). However, if a person who has never had chickenpox comes in contact with fluid from someone's skin blisters,
the person may develop chickenpox.

What are the causes?

This condition is caused by the varicella-zoster virus.

What increases the risk?

You may be at risk for Ramsay Hunt syndrome if you have had chickenpox in the past. You may be at increased risk if you are older than 60
years of age.

What are the signs or symptoms?

Symptoms of this condition include:
A rash with blisters that breaks out around the ear. The rash may be accompanied by:

A rash in the inner ear, along the side of the face, or up the scalp.

A rash inside the mouth.

Deep and severe pain in the ear.

Severe, burning pain wherever the rash develops.

Facial nerve weakness. This may cause:

Drooping on one side of the face.

Inability to close the eyelid on the affected side of the face.

Trouble eating.
:
 Loss of ability to taste on the side of the tongue.

If RHS affects the inner ear nerve (auditory nerve), other symptoms may be present. These may include:
Ringing in the ear (tinnitus).

Hearing loss.

A spinning sensation (vertigo).

Clumsiness.

How is this diagnosed?

This condition may be diagnosed based on:
Your symptoms.

A physical exam.

Other tests to confirm the diagnosis. These may include:

Viral culture. This test is done by swabbing the rash or blister to check for the varicella-zoster virus.

Blood tests to check for antibodies to the varicella-zoster virus. An antibody is a type of protein that is part of the body's immune
system.

Nerve conduction studies (electroneurogram).

MRI scan.

Hearing tests (audiology).

How is this treated?

This condition may be treated with:
Antiviral medicines to treat the virus.

NSAIDs, such as ibuprofen, or prescription pain relievers to control pain.

Anti-inflammatory medicines (steroids).

Antibiotic medicines, if the rash becomes infected.

If treatment starts within the first 3 days of having symptoms, it may shorten the course of the pain and rash that is caused by RHS.
Treatment may prevent your facial nerve from continuing to weaken. Without treatment, it is possible that you may not recover full use of
your facial nerve.

Follow these instructions at home:

Medicines

Take over-the-counter and prescription medicines only as told by your health care provider.

If you were prescribed an antibiotic or antiviral medicine, take or apply it as told by your health care provider. Do not stop using the
antibiotic or antiviral medicine even if your condition improves.

Ask your health care provider if the medicine prescribed to you:

Requires you to avoid driving or using machinery.

Can cause constipation. You may need to take these actions to prevent or treat constipation:

Drink enough fluid to keep your urine pale yellow.

Take over-the-counter or prescription medicines.

:
 Eat foods that are high in fiber, such as beans, whole grains, and fresh fruits and vegetables.

Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

General instructions
If told by your health care provider, use artificial tears and wear an eye patch to protect your eye until you can close your eyelid again.

Do not scratch or pick at the rash.

Put a cold, wet cloth (cold compress) on the itchy area as told by your health care provider.

Do not eat or drink spicy, salty, or acidic foods or beverages if you have blisters in your mouth. Soft, bland, and cold foods and
beverages may be easiest to swallow.

Keep all follow-up visits. This is important.

How is this prevented?

Getting vaccinated is the best way to prevent chickenpox and shingles and to protect against Ramsay Hunt complications. If you have not
been vaccinated, talk with your health care provider about getting the vaccine.

Where to find more information

National Organization for Rare Disorders: rarediseases.org

Contact a health care provider if:

Your pain medicine is not helping.

You have chills or a fever.

Your symptoms get worse.

Your symptoms have not gone away after 2 weeks.

You have any changes in vision.

Summary
Ramsay Hunt syndrome (RHS) is a rare neurologic disorder that affects the nerves in the face and the nerves near the inner ear.

This condition is caused by the varicella-zoster virus. This is the same virus that causes chickenpox and shingles.

If treatment starts within the first 3 days of having symptoms, it may shorten the course of the pain and rash that are caused by RHS.
Treatment may also prevent your facial nerve from continuing to weaken.

Treatments may include antiviral medicines, steroids, and pain medicines.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have
with your health care provider.

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