Ramsay Hunt syndrome: symptoms, treatment and recovery

nidirect lists a set of features accompanying facial palsy in Ramsay Hunt syndrome: severe pain, a rash in the hairline, ear or mouth, vertigo or dizziness, and loss of hearing and tinnitus. The facial weakness means one side of the face may droop and closing the eye can be difficult.

The NHS describes the shingles rash that can accompany it: blotches on one side of the body only that become itchy, fluid-filled blisters, which dry and scab a few days later. The first signs can be a tingling or painful area of skin and a headache or feeling unwell. In rare cases shingles can cause pain without a rash.

• Severe pain, often in or around the ear.

• A blistering rash in the ear, mouth or hairline.

• Weakness or drooping on one side of the face.

• Difficulty closing the eye on that side.

• Hearing loss, tinnitus, vertigo or dizziness.

The NHS says call 999 if somebody's face droops on one side (the mouth or eye may have drooped), a person cannot lift up both arms and keep them there, or has difficulty speaking. These can be signs of a stroke, a medical emergency.

nidirect says to contact your GP or emergency health care service urgently if you experience any type of facial weakness, and says gradual facial weakness over a period of time should also be treated as a medical emergency. It also says common causes such as Bell's palsy and Ramsay Hunt syndrome need prompt treatment within 72 hours.

For shingles itself, the NHS says to ask for an urgent GP appointment or get help from NHS 111 if the rash is on your eye or nose, you have changes to your vision, or you have a severely weakened immune system. Antiviral medicine works best if started within 3 days of the rash appearing.

The NHS explains that shingles is caused by the chickenpox virus. After chickenpox, the virus stays in the body and can be reactivated later, particularly if the immune system is weakened by stress, certain conditions or treatments like chemotherapy. In Ramsay Hunt syndrome it affects the facial nerve. The NHS lists it among the complications of shingles, alongside long-lasting nerve pain, infection of the rash, scarring, muscle weakness and eye problems.

nidirect lists Ramsay Hunt syndrome among viral infections that cause facial palsy, one of more than 60 different causes.

Both cause weakness of one side of the face. The NHS describes Bell's palsy as temporary weakness or lack of movement that usually affects 1 side of the face, with treatment more effective if started within 72 hours, and says most people get better within 6 months. It lists a drooping eyelid or mouth, drooling, dry mouth, loss of taste and a dry or watering eye as symptoms.

The clues that point to Ramsay Hunt syndrome are the shingles-type rash around the ear, mouth or hairline, severe ear pain, and ear symptoms such as hearing loss, tinnitus or vertigo, according to nidirect. Because there are more than 60 causes of facial palsy, assessment by a doctor matters.

nidirect says Ramsay Hunt syndrome is normally treated with corticosteroids as well as an antiviral to treat the shingles virus, and that your GP can discuss whether this treatment is suitable for you. For shingles in general the NHS says treatment can include painkillers, steroid tablets or medicines for nerve pain.

If you cannot close your eye, nidirect says preservative-free eye drops for use in the day and ointment at night should be used, and tape may be used to close the eye while sleeping. It describes surgical and non-surgical options for facial palsy that does not get better, including specialist facial therapy.

We did not find a UK source giving a typical recovery time for Ramsay Hunt syndrome specifically, so we have not stated one. nidirect lists possible complications of facial palsy, which include persistent facial weakness, eye problems, difficulty with speech, eating and drinking, reduced taste, facial pain and psychological distress. Outcomes vary between people.

The NHS says shingles rash can take up to 4 weeks to heal and skin may be painful for weeks after, and that post-herpetic neuralgia, pain lasting for several months after the rash has gone, is a possible complication. See your GP if complications persist or you feel anxious or low.

The NHS says you cannot spread shingles to others, but people could catch chickenpox from you if they have not had chickenpox or the vaccine. You can only spread the infection while the rash oozes fluid. Try to avoid anyone pregnant who has not had chickenpox, people with a weakened immune system and babies less than 1 month old, and stay off work or school if the rash is oozing and cannot be covered.

The NHS shingles page lists the NHS shingles vaccine for people who turned 65 on or after 1 September 2023, people aged 70 to 79 not yet vaccinated and people aged 18 and over with a severely weakened immune system. That page was last reviewed in November 2023, so check current eligibility with your GP surgery. The NHS says the vaccine helps reduce your risk and symptoms can be much milder if you still get shingles.

On the NHS, suspected Ramsay Hunt syndrome is assessed urgently by a GP or via NHS 111, or by emergency services if a stroke is possible, with referral to ENT or neurology for hearing and balance problems.

Private ENT and neurology consultations are available, but because treatment is time-critical the NHS route of same-day assessment is usually the quickest.