Ramsay Hunt syndrome

A shingles outbreak can affect the facial nerve near one of your ears, potentially causing facial paralysis and hearing loss.

Update Date: 22.12.2025

Overview
Symptoms
When to see a doctor
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Self care
Preparing for your appointment

Overview

Ramsay Hunt syndrome, also called herpes zoster oticus, is caused when the varicella-zoster virus affects certain nerves of the face. It causes a painful rash called shingles. The rash may be mostly around the ear or may affect the ear, face and mouth. This syndrome may cause changes to hearing, taste and balance. It also may cause loss of movement on the side of the face where the shingles rash occurs.

The risk of Ramsay Hunt syndrome goes up as you age or if your immune system is weakened.

Get treatment for Ramsay Hunt syndrome right away to lower the chance of any permanent health issues. A vaccine to prevent shingles can help lower the risk of Ramsay Hunt syndrome.

Facial nerve

The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face.

Symptoms

The most common symptom of Ramsay Hunt syndrome is a painful rash with fluid-filled blisters on, in or around one ear. The rash may be a shade of red, purple, or brown depending on your skin color.

Other symptoms of Ramsay Hunt syndrome may be:

  • Loss of movement, called paralysis, of the face on the same side as the rash.
  • Ear pain.
  • Ringing sound in the ear that doesn't stop, called tinnitus.
  • Hearing loss or hearing that is very sensitive.
  • Fast, random eye movements.
  • A feeling of spinning or moving, called vertigo.

With Ramsay Hunt syndrome, you may tear up in one eye. Some people taste things differently on one side of the tongue, or there may be sores on the tongue.

Facial paralysis

Weakness or loss of movement, called paralysis, in the nerves of the face may cause one corner of the mouth to droop. Weakness or paralysis also may make it difficult to close the eye on that side of the face.

When to see a doctor

Contact a healthcare professional if you have weakness or loss of movement in your face or if you have a painful rash on your face. Starting medicine to treat Ramsay Hunt syndrome withing three days of symptoms may help prevent long-term complications.

Causes

Ramsay Hunt syndrome is caused by the varicella-zoster virus. When the virus first infects a person, the disease it causes is called chickenpox. The immune system clears most of the varicella-zoster virus out of the body. But the virus can hide in nerves, waiting until the immune system is less active. Then the virus awakens and causes a rash called shingles. If the virus wakes up in certain facial nerves, that's called Ramsay Hunt syndrome.

Risk factors

Anyone who has had chickenpox can get Ramsay Hunt syndrome. The main risk factor for Ramsay Hunt syndrome is a weakened immune response. The syndrome is caused by the varicella-zoster virus in the facial nerves escaping immune system control.

The immune system may be weakened due to age, medical treatment, medicine or HIV infection.

Risk factors for getting shingles include being female and, among people age 65 and older, being physically injured. Some chronic illnesses, such as lung or kidney disease, may raise the risk of shingles as well.

Complications

Ramsay Hunt syndrome can cause lasting symptoms called complications. Long-term symptoms of Ramsay Hunt syndrome may include:

  • Weakness or lack of movement in the face that doesn't go away. Getting treatment quickly can help lower the risk of permanent facial paralysis or weakness.
  • Hearing changes. This includes loss of hearing or hearing that is very sensitive.
  • Ear pain. The damage to nerve fibers can cause pain that lasts after the rash has been treated.

Prevention

The shingles vaccine lowers the risk of getting shingles and related conditions such as Ramsay Hunt syndrome. This vaccine is often recommended for people over age 50 or adults of any age who have weakened immune systems.

Also, getting the vaccine against chickenpox as a child may lower the risk of serious illness from shingles later in life. The first children to get chickenpox vaccines aren't old enough to be at high risk of shingles, but shingles infection does happen. Research comparing shingles in younger people finds that those who got the chickenpox vaccine had a lower rate of shingles compared with those who had chickenpox virus infection.

Diagnosis

Ramsay Hunt syndrome is often identified by a painful rash with fluid-filled blisters on, in or around one ear. Other symptoms may include ear pain, hearing changes, a feeling of spinning or moving called vertigo. There may be loss of movement, called paralysis, of the face on the same side as the rash.

To confirm the diagnosis, your healthcare professional may test a sample of fluid from one of the rash blisters.

Ramsay Hunt syndrome isn't contagious. But the virus that causes it can spread to people who haven't had or been vaccinated for chickenpox. Until the rash blisters scab over, stay physically apart from:

  • Pregnant people and newborn babies.
  • People who never had chickenpox and who never had the chickenpox vaccine.
  • People with weakened immune systems.

If possible, cover the rash blisters until they scab over.

Treatment

Get treatment for Ramsay Hunt syndrome right away to lower the risk of long-term complications. People who start treatment within three days of symptoms have a higher chance of recovering from facial paralysis. Medicines may include antivirals, corticosteroids and pain relievers.

  • Antiviral medicine. This type of medicine (valacyclovir, acyclovir, famciclovir) focuses on stopping the virus from spreading. Antiviral medicine is usually given as pills but may be given by IV if necessary.
  • Corticosteroids. Prednisone is often recommended for about five days.
  • Pain relievers. Pain medicine you can get without a prescription may be suggested. But pain from the rash can be serious. A prescription for pain medicine may be needed.

Self care

Ramsay Hunt syndrome can be very painful. To manage it, make sure to take pain relievers as directed. If the rash is itchy, use a cool, wet cloth to press on the area. Don't scratch your ear or face.

If you have trouble closing one eye because of the facial paralysis, take steps to protect your vision.

  • Use moisturizing eyedrops throughout the day if your eye becomes dry.
  • At night, apply ointment to the eye, and tape your eyelid shut or wear an eye patch.

Preparing for your appointment

You may start by seeing a member of your regular healthcare team. Then, depending on your symptoms, you may see a doctor who specializes in the nervous system, called a neurologist. Or you may see a healthcare professional focusing on the ear, nose and throat, called an otolaryngologist.

What you can do

Before your appointment, you may want to write down:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medicines, vitamins or supplements you take, including the doses.
  • Questions to ask your healthcare professional.

For shingles, some basic questions to ask your healthcare professional include:

  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Take a family member or friend along, if possible, to help you remember the information you're given.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, such as:

  • Have you ever had chickenpox? Have you had the chickenpox vaccine?
  • Have you had a sensation that the room is spinning, called vertigo?
  • Has your hearing been affected?
  • Have you noticed a change in your sense of taste?
  • What, if anything, seems to improve or worsen your symptoms?
  • Are you being treated for any chronic health conditions? If so, what treatments are you receiving?
  • Are you pregnant?

During the physical exam, your healthcare professional will closely examine your face to check for evidence of one-sided facial paralysis or a shingles rash on, in or around your ear.

© 2026 Mayo Foundation for Medical Education and Research. All rights reserved. Terms of Use