Ramsay Hunt Syndrome (Shingles in ear)

What is the Herpes Zoster Oticus?

Herpes zoster Oticus is a viral disease, also known as shingles in ear. It arises from the reactivation of the varicella zoster virus, the same pathogen that causes chickenpox. Shingles is usually noticeable as a painful rash. The causes of the outbreak are often unknown, but the main cause is the weakening of the immune system.

How does Ramsay Hunt syndrome develop?

Herpes zoster Oticus, or Ramsay-Hunt Syndrome, occurs when the herpes zoster virus affects in the facial and cranial nerves. It is the cranial nerve that controls hearing and balance. This particular virus rests in the nerve roots after chickenpox and can be reactivated if the immune system is weakened. It migrates along the nerve tracts and causes inflammation of the affected nerve tissue up to the skin, where painful wounds then develop. These wounds are caused by burst vesicles, which then form a crust and gradually heal. This rash with small blisters behind the ear and in the ear usually indicates shingles in the ear, a herpes zoster oticus.

Symptoms of Ramsay Hunt Syndrome

The symptoms of Ramsay Hunt Syndrome are different but clear. The first sign that make you recognize shingles in the ear is a burning pain under the skin. You can feel this days before the familiar blisters form. In addition, itching and hypersensitivity can occur on the affected skin area and the affected person often feels exhausted and feverish. Herpes zoster oticus can also be recognized by the following symptoms: 

  • Severe earache
  • Formation of fluid-filled vesicles on the auricle, on the earlobe and in the ear canal. In some cases, these vesicles also form on the side of the neck
  • Hearing loss that persists beyond the infection
  • Temporary or persistent paralysis on one side of the face. Unilateral facial paralysis is often accompanied by unilateral taste disorders and impaired saliva secretion.
  • Dizziness that may last for days or weeks
  • Headaches
  • Hyperacusis

Causes and diagnosis

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. From now on the virus stays in the body and withdraws into the spinal ganglia (into the nerve cell bodies along the spinal cord). There it can "slumber" inactive until it is reactivated. A reactivation can be triggered by a weakened immune system against the virus. 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. But X-rays, UV rays or contact with toxic substances can also be the trigger. 

How do you diagnose Ramsay Hunt?
The diagnosis of shingles in the ear is usually easy for the attending physician to make. A physical examination of the patient can determine the viral infection. The vesicles and redness on the ear and in the area of ​​the ear are characteristic of herpes zoster oticus. Further diagnostics are only necessary in rare problem cases. If in doubt, the doctor will have the pathogen detected in the secretion of the vesicles or - if the brain is suspected of being involved - in the cerebrospinal fluid.

Ramsay Hunt Syndrome treatment

Antiviral drugs are used to treat shingles in the ear. These drugs stop the virus from multiplying and relieve pain and improve skin symptoms within two hours.  In the case of herpes zoster oticus, anesthetic ear drops are also used to relieve the pain, and even antibiotic ear drops, as there is an additional risk of bacterial infection. Antiviral therapy should be started no later than 72 hours after the onset of the skin symptoms, so the person concerned should contact the doctor about this if he has any first suspicions. 

Home remedies

  • Cold towels or compresses alleviate the discomfort
  • Powder and creams with local anesthetics have a pain-relieving effect both in acute shingles and in post-zoster neuralgia 
  • Lots of rest and sleep so that the disease is overcome faster
  • Shingles patients are contagious - good hygiene is essential. Close contact with others, especially babies, pregnant women, young children and sick people, should also be avoided
  • Wear loose clothing as the affected areas of the skin are very sensitive to touch

Is shingles in the ear contagious?

Yes, shingles in the ear is also contagious. Chickenpox pathogens are contained in the secretion of the vesicles and that is why a patient with shingles is contagious - until the last vesicle has opened and crusted over. People who have never had chickenpox in particular can get chickenpox through contact with shingles. Shingles is just not contagious for those who have already had chickenpox, because they already carry the pathogen in their body.

How long does it take for Ramsay Hunt Syndrome to go away?

The rash and pain usually subside within three to five weeks, but about one in five patients develop a painful condition called postherpetic neuralgia, the most common complication of shingles, which is often difficult to manage.

Complications and facial paralysis

Failure to treat herpes zoster oticus can result in serious complications. This can result in hearing loss or even deafness. Peripheral fascial palsy (nerve paralysis) can also occur as a complication of herpes zoster oticus. This means that the muscles responsible for facial expressions are weak or completely paralyzed on one side. In about 80% of the cases, however, healing occurs.

Further complications can arise from the involvement of various nerves. If the vestibulochochlear nerve (inner ear) is affected, hearing loss or deafness can occur, but also ringing in ears , vertigo and nausea can occur. If other cranial nerves are affected, it can have effects such as:

  • Hiccups or difficulty swallowing
  • Mood disorders
  • Injury to the conjunctiva, cornea, or optic nerve
  • Meningitis

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