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Ramsay Hunt Syndrome

(Herpes Zoster Oticus)


Ramsay Hunt syndrome is a set of symptoms caused by the shingles virus. The virus infects a specific set of nerves that affect the ear, mouth, skin, and muscles of the face, neck, and scalp. The virus is the same virus that causes chickenpox.

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Causes    TOP

The chickenpox virus remains in the body, even after the illness has passed. In some, this virus can reactivate and cause shingles, an infection that causes inflammation along certain nerves.

With Ramsay Hunt, the infection affects a specific set of facial nerves that can affect the ear, mouth, face, neck, and scalp.

Risk Factors    TOP

Factors that may increase your chance of Ramsay Hunt syndrome include:

  • Having shingles or history of chickenpox
  • Weakened immune system
  • Family history of shingles

Symptoms    TOP

Ramsay Hunt syndrome may cause:

  • Painful, one-sided red rash in the ear, mouth, or on the tongue
  • One-sided facial paralysis, with or without a rash—Bell’s palsy
  • Dry mouth and/or eyes
  • Loss of taste
  • Hearing loss
  • Ringing in the ear—tinnitus
  • Nausea or vomiting
  • A sensation of spinning while standing still—vertigo
  • Involuntary eye movement—nystagmus

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. A diagnosis can often be made based on history and physical exam.

Lab tests may need to be done to confirm shingles or identify other infectious causes.

Treatment    TOP

Treatment for milder symptoms is usually not needed. For moderate or severe symptoms medication may be needed to reduce the intensity or duration of symptoms. Options include:

  • Antiviral medication—may shorten the duration of the infection when taken early
  • Corticosteroids—to reduce inflammation around the nerve
  • Benzodiazepines—to reduce vertigo symptoms
  • Pain medication

Other treatments are based on the symptoms that are present. Eye care may be needed if the infection is making it difficult to completely close your eyes.

Prevention    TOP

The herpes zoster vaccine may decrease the likelihood of getting shingles, including Ramsay Hunt syndrome.

The vaccine is recommended for most people aged 50 years and older. It is important to note that people with a weakend immune system have a higher risk of developing shingles.


National Institute of Neurological Diseases and Stroke


Canadian Neurological Sciences Federation


Herpes zoster. EBSCO DynaMed Plus website. Available at: Updated September 19, 2016. Accessed October 3, 2016.
Herpes zoster oticus. Genetic and Rare Diseases Information Center. Available at: Accessed May 31, 2016.
Information. Ramsay Hunt website. Available at:
...(Click grey area to select URL)
Accessed May 31, 2016.
NINDS herpes zoster oticus information page. National Institute of Neurological Diseases and Stroke website. Available at:
...(Click grey area to select URL)
Updated February 14, 2011. Accessed May 31, 2016.
Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at:
...(Click grey area to select URL)
Updated January 10, 2011. Accessed May 31, 2016.
Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(2):149-154.
Last reviewed May 2016 by David Horn, MD
Last Updated: 5/31/2016

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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