Ramsay Hunt syndrome (also known as ‘Herpes zoster oticus’) is a virus infection of the geniculate ganglion of the facial nerve that occurs when a shingles infection affects the facial nerve. Ramsay Hunt syndrome is typically associated with a red rash and blisters in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. It is caused by reactivation of herpes zoster virus that has previously caused chickenpox in the patient. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear. So, the virus infects the facial nerve that normally innervates controls the muscles of the face.



In some cases, shingles may cause some early symptoms that develop a few days before the painful rash first appears. These early symptoms can include:

  • a headache;
  • burning, tingling, numbness or itchiness of the skin in the affected area;
  • a feeling of being generally unwell and
  • fever

Eventually, most people with shingles experience a localised "band" of pain in the affected area. The pain can be a constant, dull or burning sensation and its intensity can vary from mild to severe. Pain is less common in young healthy people and is rare in children. It usually starts a few days before the rash appears and can remain for a few days or weeks after the rash has healed.

The shingles rash usually appears on one side of the body and develops on the area of skin related to the affected nerve. Initially, they appear as red blotches on the skin before developing into itchy blisters similar in appearance to chickenpox.  New blisters may appear for up to a week, but a few days after appearing they become yellowish in color, flatten and dry out. At the same time, the patient experiences facial weakness or paralysis on the same side as the affected ear.

If someone has Ramsay Hunt syndrome, they might also experience:

  • Ear pain;
  • Hearing loss;
  • Ringing in the ears;
  • Difficulty closing one eye;
  • Vertigo;
  • A change in taste perception or loss of taste



Ramsay Hunt syndrome is caused by the same virus that causes chickenpox. After chickenpox heals, the virus lies dormant in the nerves. If the virus reactivates and affects the facial nerve, the result is Ramsay Hunt syndrome. It is not known exactly why the virus is reactivated, but it is linked to having lowered immunity. This can happen as a result of old age, physical and emotional stress, HIV and AIDS, recently having a organ or bone marrow transplant or chemotherapy.


Risk Factors

Anyone who has had chickenpox can develop Ramsay Hunt syndrome. But it is more common in older adults, typically affecting people older than 60.

Another risk groups are:

  • Anyone who's never had chickenpox or vaccination for chickenpox
  • Anyone who has a weak immune system
  • Newborns
  • Pregnant women



Complications of Ramsay Hunt syndrome may include:

  • Permanent hearing loss and facial weakness;
  • Eye damage;
  • Postherpetic neuralgia.



Children are now routinely vaccinated against chickenpox, which greatly reduces the chances of them becoming infected with the naturally occurring chickenpox virus. A shingles vaccine for people older than 60 also is available.