What Is Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is one of the main causes of peripheral facial paralysis. It can also cause other symptoms such as hearing loss and dizziness. Next, we will explain this condition in detail.

Ramsay Hunt syndrome is a consequence of the chickenpox virus. It comprises a set of symptoms and signs that arise from the fact that this viral agent is capable of affecting certain nerves. Specifically, the facial nerve.

The facial nerve contains motor and sensory fibers. It innervates different parts of the face, so it helps us with various gestures, such as those we do when eating and talking.

Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the ear on the same side. It’s a pretty frequent condition. So below we’ll explain everything you need to know about it.

What is Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is one of the diseases caused by the varicella-zoster virus. This particle belongs to the herpesvirus family.

According to an article published in the journal Anales de Medicina Interna, Ramsay Hunt syndrome consists of a paralysis of the facial nerve. In addition, it is usually accompanied by eruptions with blisters in the pinna or even inside the mouth.

It is the second most frequent cause of peripheral facial nerve palsy. In fact, it represents 7% of all of them. This is because varicella-zoster virus infection is very common in the general population.

Another study published in the SEMERGEN Family Medicine states that the clinical picture is very varied. That’s why it’s generally classified into 4 stages based on severity. The complete form, or rather the first one that was described, includes the following signs:

General infectious syndrome, with malaise, fatigue and pain.
Skin rash and hearing loss.
Impairment of taste sensations.
Peripheral facial palsy.

Causes of Ramsay Hunt Syndrome

The cause of Ramsay Hunt syndrome is the varicella-zoster virus. It occurs in people who have had chickenpox. This is due to the fact that this virus is able to remain latent in the body. Specifically, it tends to lodge in nerve tissue.

When the virus is reactivated, symptoms appear. As an article in the Department of Health states , it is often transmitted from person to person by touching the blisters of someone currently infected.

However, it can also travel through the air through droplets that are expelled when you cough or sneeze, and even through contaminated objects. It is essential to have been infected with this virus to develop Ramsay Hunt syndrome.

Chickenpox is the necessary precondition for this syndrome to appear later, sometimes many years later.

Risk factors

Ramsay Hunt syndrome can show up in anyone who has had chickenpox. This is an essential condition for this. It is important to understand that this syndrome is not contagious.

As with herpes zoster, when it appears, what can be transmitted is the virus itself. If a person who has not had chickenpox comes into contact with someone who has Ramsay Hunt syndrome, what he or she will develop will be the typical picture of rash disease.

It is also important to highlight that nowadays there are vaccines for this virus. Therefore, a vaccinated person is not at risk of becoming infected with the virus.

The question of age is fundamental. It is very rare for children to develop Ramsay Hunt syndrome. It is a syndrome that usually appears in people over 60 years of age. It is also more common in people with a weakened immune system.

What are the symptoms?

As we saw in the first section, Ramsay Hunt syndrome has a highly variable clinical expression. As explained by Mayo Clinic experts, the two main symptoms are facial paralysis and rash. It usually appears around or inside the ear. In addition, fluid-filled vesicles appear.

In some cases, the rash does not appear or appears after the paralysis. There will be an earache, constant tinnitus or even hearing loss.

With facial paralysis, it is difficult to close the eye on the affected side. The mouth and eyes may become dry. This is because the facial nerve also innervates the glands responsible for secreting tears and saliva.

Taste can also be changed. The ability to taste food with the most anterior part of the tongue is lost.

Complications of Ramsay Hunt Syndrome

Ramsay Hunt syndrome can cause long-term complications. One of the most important is postherpetic neuralgia. It refers to chronic pain that remains in the area where the rash occurred.

It arises because nerve fibers are damaged by the presence of the virus. Likewise, facial sensitivity and hearing can be reduced or permanently impaired. However, this is a little less frequent.

Finally, it is possible that, due to the inability to close the eyes during Ramsay Hunt syndrome, eye damage may occur. Particles or agents that damage the cornea can enter, affecting vision.

How is Ramsay Hunt syndrome diagnosed?

Diagnosis of this disease is usually based on the patient’s symptoms and medical history. As it is the second most common cause of peripheral paralysis, it is always important to consider it.

In addition, as explained in a study published in the Revista Clínica de Medicina de Familia, there are a number of tests that can help in the diagnosis. The first is serology. It consists of detecting antibodies against the varicella-zoster virus in the blood.

Another that can help is the polymerase chain reaction (PCR). In some cases, if the diagnosis is uncertain, imaging tests can be performed to rule out other etiologies. The most used is the MRI.

The use of imaging tests in this syndrome is only justified if it is necessary to rule out other suspicious pathologies, such as a brain tumor.

Available treatments

The treatment of Ramsay Hunt syndrome aims to reduce the risk of possible complications and discomfort for the patient. For this reason, the most used medications are analgesics. They try to reduce the pain caused. In case of vertigo, anxiolytic medications may also be prescribed.

Antivirals are used to prevent the virus from continuing to multiply. The most useful against varicella-zoster virus are acyclovir and valacyclovir. They can be combined with corticosteroids to increase their effect.

Ramsay Hunt syndrome is secondary to chickenpox

What we should keep in mind is that this syndrome only occurs in people who have already been infected with the varicella-zoster virus. It usually appears years after infection, especially in the elderly.

It is characterized by facial nerve palsy and vesicular eruption. In the face of any of the symptoms, you should see a doctor. By establishing an appropriate treatment, it is possible to reduce the risk of long-term complications such as chronic pain.