Ramsay Hunt Syndrome: Shingles in the ear

If you had chickenpox in childhood, the virus that caused it is still alive in your body and can reactivate later in life. It lives on in a dormant state in the neurons (nerve cells) that cluster in nerve enlargements called ganglia. If it suddenly awakens as you age, it can migrate down the nerves because these connect the ganglia to skin and other tissues. An eruption on the skin from this reactivating virus is called shingles. Ramsay Hunt syndrome, or Herpes Zoster Oticus, is a type of shingles that affects the skin in or near the ear, and causes weakness of the face, vertigo, and hearing loss.

Read more: Ramsay Hunt Syndrome: Shingles in the ear

It usually begins with deep pain in the ear as the virus begins to migrate down the nerves toward the skin. Once it reaches the skin, red bumps that are exceptionally sore to the touch appear, and eventually these form clusters of small but painful blisters. These are found on the ear or inside the ear canal and can even spread over the side of the face near the ear.

At the same time the virus attacks the skin, it can also migrate down other nearby nerves and cause damage. In Ramsay Hunt syndrome the virus attacks a nerve on one side of the face that affects the muscles controlling facial movement. This will be on the same side as the ear pain and rash. The face on that side will droop and the eyelid may not close properly. If the zoster virus also migrates to the inner ear, you can develop vertigo to the point of seeing the room spin, and you may notice ringing in the ear or loss of hearing.

You should be seen urgently if this happens, because medications can help control the virus and reduce the swelling in the nerves that cause some of the damage to the ear and face. You need to be seen within the first few days to have the best chance of full recovery. The facial paralysis can improve over time, but there may be some residual weakness. The hearing can improve with treatment also. If there is permanent damage to the balance part of the inner ear, symptoms of dizziness and imbalance tend to improve over the first few weeks but may take months to completely resolve. Our series on recovery begins with this post.

The vaccine to prevent shingles (Shingrex) also helps prevent Ramsay Hunt syndrome. You become more likely to have virus reactivation after age 50. Reactivation is very common, up to half of people by the time they reach 80 years of age, so it’s worth considering the vaccine any time after you reach 50.