There are many articles online highlighting the differences between Ramsay Hunt Syndrome and Bell’s palsy. Many of them speak of these two disorders as separate illnesses.
In this article, we would like to highlight the similarities between Ramsay Hunt Syndrome and Bell’s palsy, to show that they are, in fact, almost the same.
Sometimes we hear our patients saying “I was misdiagnosed with Bell’s palsy at first, when I actually have Ramsay Hunt Syndrome”. They become frightened that all this time they were treated for Bell’s palsy, when they actually had Ramsay Hunt Syndrome, and this is what led to long recovery and complications.
Some neurologists might write Bell’s palsy as a diagnosis instead of Ramsay Hunt Syndrome. Technically, this is not wrong. Let’s see why.
Estimated reading time: 6 minutes
What is Ramsay Hunt Syndrome?
Let’s discuss Ramsay Hunt Syndrome first. Ramsay Hunt Syndrome is a diagnosis given to peripheral facial palsy when it is caused by varicella zoster virus infection (shingles). Varicella zoster virus belongs to the herpetic virus group.
How does varicella zoster virus injure the facial nerve?
The virus itself does not “attack” the nerve. The activation of the virus leads to inflammation around the facial nerve. The inflammation causes the surrounding tissues to swell and compress the facial nerve.
Our facial nerve on the way to the muscles passes through a very narrow bone channel in the pyramid of the temporal bone (behind the ear). Since the space inside the channel is limited, the facial nerve becomes easily susceptible to compression.

The resulting compression disrupts the supply of oxygen, water, glucose, and other nutrients to the nerve fibers. Without these nutrients, the facial nerve fibres sustain damage. The longer the compression remains, the bigger is the damage to the facial nerve.
Why does the recovery after Ramsay Hunt Syndrome take so long?
Shingles, or varicella zoster virus, usually require at least a few days or even a week to be treated. This causes the facial nerve to remain compressed for a longer time, leading to deeper damage. The bigger the damage to the facial nerve, the more time it will require for regeneration.
This is why in most cases, Ramsay Hunt Syndrome usually follows a long recovery scenario and takes a long time (several months) until the first improvements become visible. In most cases, it also results in unwanted complications such as synkinesis, asymmetric smile, facial pains and tensions.
Ramsay Hunt Syndrome vs Bell’s palsy
Both diagnoses refer to the same resulting functional disorder – unilateral peripheral facial paralysis. The only difference is the causing factor.
Ramsay Hunt Syndrome is a diagnosis name for peripheral facial palsy when it is caused as a result of herpetic viral infection.
Bell’s palsy is a diagnosis name for peripheral facial palsy when the cause is unknown or could not be determined (idiopathic). In other words, it is a diagnosis of exclusion. When all other known causes are dismissed (including herpes virus), the diagnosis is “Bell’s palsy”.
Let’s elaborate on this with an analogy.
Peripheral facial palsy can be compared to a broken leg. Both happen suddenly and require time to heal through tissue regeneration.
A leg can be broken due to a variety of reasons, but the resulting condition is the same – a broken leg.
It needs time to heal, and there is very little one can do to speed up its recovery – the bone (and nerve) tissues will regenerate only at the speed determined by laws of nature. If the recovery is long, and you do not provide optimal conditions for it, you may have residual effects or develop complications, such as limping in case of a broken bone.
Whether it was broken because of an unlucky fall, or because something heavy dropped on your leg, the result remains the same – a broken bone. It does not matter what caused it to break.
It is exactly the same with facial paralysis. Although facial nerve fibres may be a little more complex and more difficult for our body to regenerate than bone tissues, the principle remains the same.
There can be many causes for facial paralysis: local overcooling, viral infection, bacterial infection, Lyme disease, Otitis media, Herpes virus, tumors, etc. In the end, they all result in the same effect – a damaged facial nerve.
The main difference between Ramsay Hunt Syndrome and Bell’s palsy
The only significant difference between these two diagnoses is the treatment that may be prescribed by your doctor in the early stages. Since the causing factors are different, they may require different medications to address the causing factor.
Bell’s palsy
Because the cause is often unknown, a doctor will usually prescribe general steroids to reduce the swelling that causes facial palsy during Bell’s palsy. Anti-viral and anti-bacterial medications are not always prescribed.
Ramsay Hunt Syndrome
For Ramsay Hunt, besides prescribing the steroids to fight the inflammation, the doctor will also prescribe specific medication to fight the varicella zoster virus.
Note: this is not a medical advice. Please follow your doctor’s recommendations for acute recovery.
Conclusion
If the facial palsy is caused by Herpes virus – the diagnosis is Ramsay Hunt Syndrome.
If the facial palsy is caused by an unknown factor, then the diagnosis will be Bell’s palsy.
In the end, the resulting condition for both is the same – peripheral facial palsy. That is why Ramsay Hunt Syndrome and Bell’s palsy are pretty much the same.
Whatever is the cause, the facial palsy recovery will progress according to two most likely scenarios – it will either follow a quick recovery or will take a longer time.
In the case of Ramsay Hunt Syndrome, since Herpes zoster virus can lead to a big infection and take a longer time to eradicate, it can cause bigger damage to the facial nerve and lead to a longer recovery.
As we discuss in another article, the longer the recovery, the higher are the chances for long-term complications and residuals to develop.
If that is your case, feel free to reach out to us or register for an online diagnostic session, so we can take a better look at your condition and give detailed advice on what may help you to reduce synkinesis, facial pains, the tension of facial muscles, and make your smile more symmetric.
Suggested article:
Gabriela’s journey of Ramsay Hunt Syndrome recovery.
