Up to $2,500 off premium devices* Book now

Ramsay Hunt Syndrome (RHS)

Causes, Symptoms, and How to Treat it

About the Ramsay Hunt Syndrome, or Herpes Zoster Oticus

Herpes zoster oticus, also referred to as Ramsay Hunt Syndrome or ear shingles, is a viral condition. It results from the reactivation of the varicella-zoster virus, the same pathogen responsible for chickenpox, and typically manifests as a painful rash. While the exact causes of these outbreaks are unclear, a weakened immune system is a significant contributing factor.

When does Ramsay Hunt syndrome start?

Ramsay Hunt Syndrome occurs when the herpes zoster virus affects the facial and cranial nerves, particularly the ones responsible for hearing and balance. This virus lies dormant in the nerve roots after an initial bout of chickenpox but can reactivate when the immune system weakens. It travels along the nerves, causing an inflammation that leads to painful sores. These sores, resulting from burst vesicles, eventually crust over and heal. This rash with small blisters around and inside the ear often indicates shingles in the ear, known as herpes zoster oticus.

What are the symptoms of the Ramsay Hunt syndrome?

Ramsay Hunt Syndrome symptoms include:

  • Severe earaches
  • Formation of fluid-filled blisters on the ear, earlobe and ear canal
  • Potential blistering on the neck
  • Persistent hearing loss
  • Temporary or ongoing facial paralysis, often accompanied by taste and saliva issues on one side
  • Prolonged dizziness
  • Headaches
  • Heightened sensitivity to sounds, known as hyperacusis

This condition typically starts as a burning pain under the skin, days before the appearance of blisters. However, it is also characterised a feeling of fatigue, fever and itching and heightened sensitivity in the affected area.

What causes the Ramsay Hunt syndrome?

Herpes zoster oticus can theoretically break out in anyone who has had chickenpox. As soon as a person becomes infected with the varicella-zoster virus (VZV) for the first time, the first thing they do is get chickenpox. Once a person has caught the chickenpox, the virus stays in the body and withdraws into the spinal ganglia (into the nerve cell bodies along the spinal cord). There it can remain inactive until it is reactivated. A reactivation can be triggered by a weakened immune system. Age or the suppression of the body's own immune system, such as that caused by HIV, can be the causes of a fluctuating or weakened immune system. X-rays, UV rays or contact with toxic substances can also be the trigger.

How is Ramsay Hunt syndrome diagnosed?

The diagnosis of ear shingles is typically straightforward as it involves a physical examination that identifies symptoms indicative of herpes zoster oticus, such as vesicles and redness in the ear and its surrounding area. Further diagnostic tests are rarely required and are usually reserved for the more unusual and complex cases. However, if there is any doubt, the doctor may opt to analyse the fluid secreted from the vesicles or examine the cerebrospinal fluid.

Can Ramsay Hunt syndrome be cured?

To cure ear shingles, doctors usually prescribe antiviral medications. These medications  suppress the replication of the virus and, within a few hours, offer pain relief and treat skin symptoms. In some cases, doctors might suggest anaesthetic ear drops to ease discomfort. Alternatively, antibiotic ear drops are prescribed to reduce the possibility of a bacterial infection. Initiating antiviral treatment within 72 hours of the emergence of skin symptoms is crucial.

Natural remedies

To alleviate discomfort from shingles, you can use cool towels or compresses and apply powders or creams containing local anaesthetics, which offer pain relief in both acute shingles and post-zoster neuralgia. Adequate rest and sleep are essential for a faster recovery. It is also important to practice good hygiene, since shingles patients can be contagious, and avoid close contact with others, particularly infants, pregnant women, young children, and individuals who are unwell. Additionally, it is best to wear loose-fitting clothing as the affected skin areas can be highly sensitive to touch.

Ramsay Hunt Syndrome: FAQs

Is Ramsay Hunt syndrome contagious?

Yes, it is. Shingles in the ear can also be contagious. The virus responsible for chickenpox resides in the secretion of the vesicles, making individuals with shingles contagious until the last vesicle has crusted over. Those who have never had chickenpox, in particular, can contract it through contact with someone with shingles. However, shingles is not contagious for those who have already had chickenpox as they already carry the virus in their body.

Is Ramsay Hunt permanent?

In most cases, the rash and pain tend to subside within a span of three to five weeks. However, approximately one out of every five patients may develop postherpetic neuralgia, a painful complication of shingles that can be quite challenging to treat.

What is the complication of Ramsay Hunt syndrome?

Although healing occurs in about 80% of cases, neglecting herpes zoster oticus treatment can lead to serious complications, including hearing loss, deafness and peripheral facial palsy. However, if the inner ear's vestibulocochlear nerve is affected, it can result in hearing loss, deafness, tinnitus, vertigo, and nausea. Damage to other cranial nerves may lead to issues like hiccups, swallowing difficulties, mood disorders, conjunctival or corneal injury, or even meningitis.

Have your hearing tested

The best way to treat hearing loss is through prevention. Make an appointment at one of our Amplifon clinics to have your hearing health checked. You will learn more about our hearing solutions and different types of hearing aids.

Get support and advice

Request an appointment

Book now

Take an online hearing test

Take the test

Find a clinic near you

Find a clinic