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What is Ramsay Hunt Syndrome?

Your doctor just told you, “You have Ramsay Hunt Syndrome”. You would like to know what it is, how it happened, and most importantly will it go away and how soon. We created this article specifically to answer these questions and explain what Ramsay Hunt is and what it means for you.

Estimated reading time: 7 minutes


What is Ramsay Hunt Syndrome?

The generic name of this functional disorder is peripheral facial paralysis that has been caused by herpes virus. So when the cause of your facial palsy has been established as a herpetic infection, it gets the name Ramsay Hunt Syndrome.

If the cause of your facial palsy cannot be established, it gets the name Bell’s palsy. This is the main difference between Ramsay Hunt Syndrome and Bell’s palsy.

What is herpes virus?

Herpes virus, that relates to Ramsay Hunt Syndrome, is sometimes also known as shingles or cold sores. Ramsay Hunt is not a common consequence of these sores. It usually occurs only in very heavy cases, when the infection spreads to the area behind the ear.

Often, bacteria and viruses can live in a dormant state in our bodies. They remain suppressed by our immune system. If something reduces our immune system, these pathogenic organisms can resurface and cause inflammation in particular areas.

The herpes virus usually “sleeps” in the tissues of our nerves. It can remain in the dormant, “sleeping” state for your whole life, and you might not even know you have it. However, if due to certain factors your immune system is weakened, the virus can “wake up”.

A few factors that can contribute to the weakening of your immune system include:

  • stress
  • physical exhaustion
  • extensive and strong cold
  • high blood pressure
  • high sugar levels
  • last weeks of pregnancy

How herpes virus causes Ramsay Hunt?

When the herpes virus switches from dormant into active state, it can travel upwards along the facial nerve, to the area around the ear. If it becomes very active, it will cause a strong inflammation, affecting the area where the facial nerve runs within a long and narrow bone channel – the pyramid of temporal bone (it is the area just behind our ears).

Facial nerve in the pyramid of temporal bone
Facial nerve in the pyramid of temporal bone

Inflammation in this channel will cause swelling that compresses the facial nerve, which leads to its damage. We discuss this process in detail in the article “What is Bell’s palsy“.

Damage to the facial nerve during Ramsay Hunt Syndrome

If you ever experienced cold sores or shingles, you will know that it is a very nasty inflammation, that usually takes some time to treat. It does not go away quickly.

This is one of the most predominant factors of Ramsay Hunt Syndrome – the active state of the inflammation takes a long time. This leads to a deeper damage to the facial nerve fibres in the affected area.

While Bell’s palsy may cause varied levels of damage to the facial nerve, Ramsay Hunt Syndrome, in the majority of cases, will result in substantial injury to the facial nerve resulting in a long recovery process.

Which is why it is very important to go to your doctor as soon as possible when you suddenly find out you have a facial paralysis on one side of your face. Your doctor will establish the cause and prescribe any necessary medications.

Especially in the case of Ramsay Hunt Syndrome, it is extremely important to start with antivirals and steroids as soon as possible. Your aim is to reduce the active inflammation and swelling around the facial nerve, to try to prevent extensive damage.

Diagnosing Ramsay Hunt Syndrome

Ramsay Hunt Syndrome can be easily established if you have visible sores on your skin or inside your ear. In this case, your doctor can detect that the cause of your facial palsy is herpes virus, and will prescribe the necessary medications.

However, it might not always be that easy. In our experience, it is possible that you may have herpetic infection around the facial nerve, even if there are no visible sores.

Ramsay Hunt Syndrome, very often, is accompanied by very intense headaches. These headaches can originate within or around your ear, and radiate towards the head, or even spread to your neck and shoulder on the affected side. These headaches can be so intense, that even painkillers cannot help to reduce them. Usually, the presence of these pains implies a very strong inflammation. It can be caused by herpes virus, or other pathogenic infections.

If you experience, such intense headaches together with your facial paralysis, our advice is to insist to your doctor to make a test for antibodies of a herpes virus. This test that can help establish correct diagnosis and medications. In the case of Ramsay Hunt Syndrome, it is vital to treat the active infection as soon as possible, in the attempt to prevent a deeper damage to your facial nerve.

What if you were diagnosed with Bell’s palsy before Ramsay Hunt Syndrome?

We often hear our patients saying, “I was first diagnosed with Bell’s palsy. Later, it turned out I had Ramsay Hunt Syndrome”.

To this, we usually reply that during the acute stage, the correct diagnosis matter, because during Ramsay Hunt Syndrome, apart from steroids, you should also take antivirals.

On the later stages of recovery, it does not matter anymore, if you had Bell’s palsy or Ramsay Hunt Syndrome. We explain this in detail in a dedicated article about the difference between Bell’s palsy and Ramsay Hunt.

What you need to understand, is that once the damage to the facial nerve happens, it does not really matter what caused it (as long as it was not mechanically cut during surgery or due to the injury). In the case of Ramsay Hunt, it is the herpes virus. In the case of Bell’s palsy, the cause of the damage to the facial nerve is unknown (it is idiopathic).

Essentially, both Bell’s palsy and Ramsay Hunt Syndrome are facial paralyses. Therefore, once the paralysis happens, the recovery will follow the same process in both Bell’s palsy and Ramsay Hunt.

Recovery prospects after Ramsay Hunt Syndrome

If it was established that it is indeed herpes virus that caused your facial palsy, especially if it was a very strong infection, then the subsequent recovery of the facial nerve will usually take a long time.

Herpes virus can cause deep damage to your facial nerve. To recover from this, your facial nerve will need at least 3 or 4 months, because the first nerve fibres begin to reconnect to the facial muscles, and you can start seeing first improvements. In some heavy cases, it can even take longer. Take a look at Gabriela’s story and her process of recovery after Ramsay Hunt.

Once the first movements begin to return, your Ramsay Hunt finishes. In our experience, if the recovery takes long (longer than 1 month until you see first improvements), the probability of developing complications and residuals is high.

This can include synkinesis, facial pains and spasms, asymmetric smile, excessive tears or lack of them. Unfortunately, from the experience of our patients, these complications will not go away by themselves. You need to actively work on improving them, under professional supervision. We are here to help you on this journey of bringing your smile back. Speak with us.

Alex Pashov

Alex Pashov

Co-founder of Crystal Touch clinic and Bell's palsy expert.

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