What is Ramsay Hunt Syndrome?

You might already be familiar with shingles, the painful rash that occurs when a nerve and the skin around it are infected by reactivated chickenpox virus (varicella-zoster virus). Ramsay Hunt syndrome is an outbreak of shingles limited to the facial nerves near your ears.

Shingles (herpes zoster) affects approximately 1 out of every 3 people in the United States. Ramsay Hunt syndrome is much more uncommon, and the effects can be particularly uncomfortable due to the location on the face. If not treated quickly, Ramsay Hunt syndrome can result in issues with hearing, balance and speech, the latter due to facial paralysis.

Anyone who has had chickenpox is susceptible to developing shingles or Ramsay Hunt syndrome because the virus lives in the body and can remain dormant for many years.

What are Ramsay Hunt Syndrome symptoms?

The primary Ramsay Hunt syndrome symptoms are facial paralysis and a rash affecting the ear. The severity of the symptoms can vary by person, but the onset is typically sudden and presents similarly to Bell’s palsy, a more common condition that also causes facial paralysis.

However, Ramsay Hunt syndrome is distinct because it is accompanied by a blistering rash in the ear, hearing loss and pain when the ear is touched. Additional symptoms include:

• Difficulty closing one eye
• Tinnitus
• Vertigo
• Loss of taste
• Dry mouth and eyes

What causes Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is caused by a reactivation of the chickenpox or varicella-zoster virus. When the virus reactivates, it attacks and infects the facial nerve nearest to the inner ear.

Reactivation of the virus is often the result of a weakened immune system. This can happen naturally with age or stress. It can also be a result of treatments or medications taken for other conditions that have the side effect of weakening your immune system. 

How is Ramsay Hunt Syndrome diagnosed?

It is imperative to be seen by a healthcare provider if you have symptoms of Ramsay Hunt syndrome. Delaying treatment, even in a matter of days, can result in permanent complications. A thorough exam might include neurological tests, blood tests and imaging to rule out other causes. Only a qualified healthcare provider can give you a Ramsay Hunt syndrome diagnosis.

Ramsay Hunt Syndrome treatment

Ramsay Hunt syndrome treatment typically includes a high-dose steroid and antiviral medication. Patients might also be prescribed eye drops and ointments for the rash, and other treatment options might be explored based on the individual’s needs. Additional treatments could include:

• Pain relievers
• Medication to relieve vertigo
• Anti-seizure medication

Home remedies such as cold compresses can also help relieve some discomfort.

What is the recovery time for Ramsay Hunt Syndrome?

Most people recover fully, but Ramsay Hunt syndrome recovery time and degree can vary by person, lasting from weeks to months. Better results can correlate to early treatment, which is why patients need to be treated as soon as symptoms occur.

Can you die from Ramsay Hunt Syndrome?

Ramsay Hunt Syndrome (RHS) is generally not fatal, but it can cause serious health issues if left untreated. It occurs when the varicella-zoster virus—the same virus responsible for chickenpox and shingles—affects the facial nerve near the ear. Common symptoms include facial paralysis on one side, ear pain, hearing loss, tinnitus, dizziness, and sometimes a painful rash around the ear or mouth.

Although death from Ramsay Hunt Syndrome is extremely rare, complications can still occur. These may include permanent facial nerve damage, persistent hearing loss, or chronic balance problems. In very rare cases, especially in individuals with weakened immune systems, the virus can spread to the brain or other organs and cause potentially life-threatening conditions such as encephalitis (brain inflammation).

Immediate medical attention is essential if symptoms become severe—such as confusion, seizures, or difficulty breathing.

The good news is that early treatment with antiviral medications and corticosteroids can significantly improve the chances of recovery and helps reduce the risk of long-term complications. While Ramsay Hunt Syndrome can be painful and disruptive, it is not typically life-threatening when properly diagnosed and treated in time.

How long does Ramsay Hunt Syndrome last?

The duration of Ramsay Hunt Syndrome (RHS) can vary significantly from person to person. In many cases, symptoms begin to improve within a few weeks if treatment starts early—ideally within 72 hours of the first signs. For mild cases, full recovery may occur within a few weeks to a couple of months.

However, in moderate to severe cases, recovery can take several months, and some people may continue to experience lingering symptoms such as facial weakness, hearing loss, or balance issues. The effectiveness of treatment depends on several factors, including the severity of the nerve damage, the patient’s overall health, age, and how quickly antiviral medications and corticosteroids are started.

Unfortunately, Ramsay Hunt Syndrome can sometimes cause permanent damage. If treatment is delayed or the nerve involvement is severe, long-term complications may occur. These may include permanent facial paralysis, chronic tinnitus, hearing loss, or difficulty closing the eye on the affected side. Even after recovery, some individuals may experience facial twitching or weakness.

Does Ramsay Hunt Syndrome go away?

Yes, Ramsay Hunt Syndrome (RHS) can go away, but recovery varies widely depending on the severity of the condition and how quickly treatment begins. In many cases, especially when diagnosed early and treated within 72 hours, symptoms can significantly improve or even fully resolve within a few weeks to a few months. Early treatment with antiviral medications and corticosteroids increases the chances of a full recovery and reduces the risk of complications.

However, not everyone fully recovers. In more severe cases, or when treatment is delayed, some symptoms—such as facial weakness, hearing loss, tinnitus, or balance problems—may become long-lasting or permanent. Around 30% of people with RHS experience some degree of lasting facial nerve damage.

So, while Ramsay Hunt Syndrome often does go away, especially with prompt medical care, it does not always resolve completely. If you suspect RHS, it’s essential to seek medical attention immediately to improve the chances of full recovery and minimize long-term effects.

How do you get Ramsay Hunt Syndrome?

Ramsay Hunt Syndrome (RHS) is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox and shingles. After a person recovers from chickenpox, the virus remains dormant in the body’s nerve tissue. RHS develops when the virus becomes active again and affects the facial nerve near the ear, leading to symptoms such as facial paralysis, ear pain, dizziness, and a painful rash.

You cannot get RHS unless you’ve had chickenpox in the past. The virus typically reactivates when the immune system is weakened, which can occur due to age, illness, or other health-related factors.

While getting Ramsay Hunt Syndrome more than once is rare, it is possible. Recurrence can happen, especially in people with weakened immune systems, such as those with autoimmune diseases or undergoing cancer treatment. Although drugs and stress do not directly cause RHS, they can contribute to its development by weakening the immune system. For example, long-term use of immunosuppressive medications or experiencing chronic stress may increase the risk of viral reactivation.

What does Ramsay Hunt Syndrome look like?

Ramsay Hunt Syndrome (RHS) presents several visible symptoms that can affect the face, ear, and sometimes the mouth. One of the most noticeable signs is facial paralysis or weakness on one side of the face. This can cause a drooping appearance around the mouth and eyelid, making it difficult to smile, close the eye, or raise the eyebrow on the affected side.

Another key symptom is a painful red rash or group of fluid-filled blisters in or around the ear. This rash, known as herpes zoster oticus, may also appear inside the ear canal, on the earlobe, or extend to the scalp, tongue, or roof of the mouth on the same side as the facial paralysis. The affected ear may look swollen, irritated, or blistered.

RHS often includes hearing-related issues, such as hearing loss in one ear, tinnitus (a ringing or buzzing sound), and vertigo or dizziness, which can impact balance and coordination.

Other visible signs may include a dry, red eye on the paralyzed side if the eyelid doesn’t close properly, as well as drooping of the mouth, which can interfere with speaking or eating.

If these symptoms appear—especially facial weakness combined with an ear rash—it’s important to seek immediate medical attention.

Can you cure Ramsay Hunt Syndrome?

Ramsay Hunt Syndrome does not have a guaranteed cure, but many people recover fully or partially, especially when treatment begins early. The condition is caused by the reactivation of the varicella-zoster virus, and the main goal of treatment is to reduce symptoms, support nerve healing, and prevent complications.

Yes, you can recover from Ramsay Hunt Syndrome. Early treatment with antiviral medications—such as acyclovir or valacyclovir—combined with corticosteroids like prednisone can greatly improve outcomes. These medications are most effective when started within 72 hours of the onset of symptoms.

Recovery time varies. Some people with mild cases recover within a few weeks, while others may take several months. About 70% of patients recover completely if treatment is started early. However, approximately 30% may experience long-term effects, such as partial facial weakness, tinnitus, or hearing loss.

While there is no definitive cure, the condition can often be managed successfully. In addition to medication, supportive treatments like physical therapy, facial exercises, and eye protection (if the eye cannot close fully) can aid in the recovery process.

How do you sleep with Ramsay Hunt Syndrome?

Sleeping with Ramsay Hunt Syndrome (RHS) can be difficult, especially if you're dealing with facial paralysis, ear pain, dizziness, or an eye that won’t fully close. However, there are several ways to make sleep more comfortable and protect affected areas during the night.

If you’re unable to close one eye due to facial weakness, it’s important to keep the eye moist and protected while you sleep. Applying a lubricating eye ointment or artificial tears before bed can help prevent dryness and irritation. Covering the eye with an eye patch, medical tape, or a moisture chamber can also reduce the risk of corneal damage.

Your sleep position matters too. It’s usually more comfortable to sleep on your back or the unaffected side to avoid putting pressure on the paralyzed side of your face or the ear. Using extra pillows to elevate your head may help with symptoms like dizziness or vertigo.

Managing pain before bedtime is also important. Take any prescribed medications, such as antivirals, corticosteroids, or pain relievers, as directed. Keeping your bedroom quiet, dark, and cool can promote better rest.

If symptoms like pain, vertigo, or dry eye are preventing sleep, speak with your doctor about additional treatments or support to help you rest and recover.

Can you have shingles inside your ear?

Yes, it is possible to have shingles inside your ear, a condition known as herpes zoster oticus. Shingles inside the ear can cause a range of uncomfortable and potentially serious symptoms. These may include burning or stabbing pain in the ear, redness, and the appearance of fluid-filled blisters in the ear canal or on the outer ear. People often experience hearing loss, tinnitus (a ringing or buzzing sound), and a feeling of fullness or pressure in the affected ear. In some cases, the condition can also lead to dizziness or balance problems.

Because shingles in the ear involves nerve tissue, it can lead to complications if not treated quickly. If you develop any of these symptoms, it’s important to seek medical care immediately. Early treatment with antiviral medications and corticosteroids can help reduce pain, limit nerve damage, and improve the chances of a full recovery.