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Ramsay Hunt Syndrome

Reactivation of varicella-zoster virus in the geniculate ganglion causing facial palsy with painful vesicular eruption in the ear and severe vertigo.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Ramsay Hunt Syndrome?

Ramsay Hunt syndrome (herpes zoster oticus) results from reactivation of latent varicella-zoster virus in the geniculate ganglion of the facial nerve, causing inflammatory neuropathy and characteristic vesicular eruption in the cutaneous distribution of cranial nerve VII (concha, external auditory canal, soft palate).

The classic triad is ipsilateral lower motor neuron facial paralysis, severe otalgia, and herpetic vesicles in the external ear and auditory canal; vestibulocochlear nerve involvement (CN VIII) causes sensorineural hearing loss, tinnitus, and vertigo in many patients.

Diagnosis is clinical based on triad recognition; PCR of vesicle fluid confirms VZV. Differential diagnosis includes Bell palsy, otitis externa, mastoiditis, and Lyme disease. Prompt treatment within 72 hours with oral acyclovir or valacyclovir plus high-dose prednisone improves outcomes.

Symptoms

Sudden ipsilateral peripheral facial paralysis
Severe deep ear pain (otalgia)
Painful vesicular rash in external ear and canal
Sensorineural hearing loss and tinnitus
Vertigo and balance disturbance
Altered taste in anterior two-thirds of tongue
Hyperacusis from stapedius muscle paralysis

Risk Factors

Age over 60 years
Immunocompromise (HIV, chemotherapy, steroids)
Diabetes mellitus and chronic illness
Stress and physical or emotional trauma
Prior chickenpox infection (universal in adults)
Lack of zoster vaccination
Recent illness or fever causing immune suppression

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • EMERGENCY — facial paralysis with ear pain or rash
  • Sudden hearing loss with facial weakness
  • Severe vertigo with facial palsy
  • Vesicles in or around ear with neurological symptoms
  • Suspected reactivation in immunocompromised patient
  • Worsening symptoms despite Bell palsy treatment
  • Bilateral cranial nerve involvement

Treatment Methods

01
High-dose oral antiviral within 72 hours — valacyclovir 1000 mg TID for 7-10 days
02
Oral prednisone 60-80 mg daily tapered over 10-14 days
03
Pain management with gabapentin or pregabalin for postherpetic neuralgia
04
Eye protection — artificial tears, ointment, taping at night
05
Vestibular rehabilitation for persistent vertigo
06
Audiometry and ENT consultation for hearing loss
07
Facial nerve rehabilitation and physical therapy

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.