Ramsay Hunt syndrome Information – Symptoms and Treatment

The world was taken by storm when renowned singer Justin Bieber released a video on Instagram regarding his medical condition – the Ramsay Hunt Syndrome. The vocalist, with millions of followers, confronted his fans and stated that he could not blink one of his eyes and move the right part of the affected side of the face as one of the major signs of the disease.

Partial facial paralysis happens because of the affected facial nerve that runs just beneath the ear and innervates most of the facial soft tissue. This rare disease has led to speculation because RHS (Ramsay Hunt Syndrome) is an uncommon syndrome and people have little knowledge about its causes and early signs & symptoms. 

The blog attempts to explain the cause, treatment, and other relevant information to bring awareness regarding this rare disease.

What is Ramsay Hunt Syndrome?

RHS, or the Ramsay Hunt syndrome, is the major complication of varicella-zoster virus reactivation (the virus causing chicken pox). The reactivation of the virus is majorly because of the body’s weakened immune system. After primary exposure to chickenpox, varicella-zoster virus remains latent in sensory ganglion called Geniculate Ganglion. The reactivation followed by varicella-zoster virus replication leads to the formation of vesicular or fluid-filled/ herpetic-inflammatory lesions in the corresponding nerve distribution. 

The syndrome includes a triad of same-sided facial paralysis, ear pain, and vesicular rashes in the auditory canal or on the ear of the same side.

These patients may experience impaired taste perception due to affected facial nerves, tongue lesions, and hearing abnormalities in the affected ear, like hearing loss, tinnitus or ringing noise in the ear, and hyperacusis. In some cases, the patients might also complain of vertigo and lightheadedness.

The disease predilection lies in adults compared to children. 

What are the Symptoms of Ramsay Hunt Syndrome? 

A patient may discover several symptoms. Here are a few:- 

• Partial or full-face paralysis 
• Severe vertigo, where one may feel things are spinning 
• Partial hear loss
• Unbearable ear pain 
• Rashes on the earlobe, mouth roof with the affected nerve 
• Rashes on the eardrum with pain 
• Weak face making it hard to close the eye
• Making the facial movements difficult

How to Diagnose RHS?

Apart from the classical signs and symptoms of the disease, to provide the provisional diagnosis, testing the fluid sample (the one present in the lesion) is important to confirm RHS.

The use of Polymerase chain reaction (PCR) for testing the fluid sample from lesions is useful for diagnosis. Samples from ear scrapings, tears, and saliva can also be useful for diagnosis. MRI of the brain is useful to reveal the swelling and involvement of nerves, to rule out the possibility of any associated swelling in the brain or involvement of adjacent nerves. 

There are a few other diagnostic tests, such as, 

• Varicella-zoster virus blood and skin tests 
• Head’s MRI
• Lumbar Puncture 
• Electromyography 
• Nerve Conduction 

What Is The Treatment For Ramsay Hunt Syndrome?

The Ramsay hunt syndrome treatment begins with the course of RHS treatment, which involves administering antiviral drugs in combination with corticosteroids. Antiviral drugs result in the recovery of lesions/ rashes and corticosteroids because of their anti-inflammatory effect that reduces the swelling in nerve fibers. Antiviral drugs can be administered orally or intravenously, depending upon the severity of the case.

Additionally, medications for pain management are used to alleviate painful symptoms and paroxysms as the syndrome presents itself as a painful condition. Usually, antiviral medicines like valacyclovir or acyclovir are prescribed. In the worst-case scenario, steroids are injected, chiefly prednisone, which instantly reduces the inflammation.

It is advised to put on an eye patch to safeguard your cornea from any potential injury and other possible abrasions to the eye. It happens due to the weak facial nerves that the eyes do not close properly. So, any foreign object can cause trouble. Some people use artificial tears and eye lubricants to prevent the eyes from drying while sleeping. Also, other medicines are advised simultaneously if the patient experiences any dizziness or an added issue.

The RHS treatment also involves physiotherapy exercises that are often helpful in the recovery stage for facial paralysis.

What Complications Can Arise due to RHS?

• The RHS can contribute to the change in your facial expression following weakened facial nerves. 
• Patients’ taste buds may not identify certain tastes
• One may lose your visions 
• The eyelids may face spasms
• Abnormal reactions on the face may arise. For example, when you smile, your eyes tend to close 
• One may feel continuous pain 

Moreover, when the virus spreads to the adjoining nerves, it can further complicate things or even worsen them. The patient may feel weakness in limbs, perplexed, headache, drowsiness, and more.

Prognosis of Ramsay Hunt Syndrome 

The prognosis of the disease is fair to good, depending upon the severity and spread. Unfavorable prognostic factors are complete facial paralysis, advanced age, and comorbidities like hypertension and diabetes. In the long term, while most patients recover, pain, facial dysfunction like synkinesis, and scarring might be a challenge for which the patients might require botulinum toxin injections.

In the cases where the virus has little effect on nerves, the chances of recovery are higher, and a patient may recover within a few weeks. However, it may take months to years to complete recovery in case of severity. 

The possibility of completely cured nerves is higher if the patient starts the treatment within three days of noticing symptoms.

Prevention for Ramsay Hunt Syndrome

So far, no prevention has been found for RHS. However, if the person has suffered from chicken pox in the earlier stages of life, they must strengthen their immune system to prevent the reactivation of the virus.

Also, after diagnosing it, they should start their treatment immediately to recover fully. 

Conclusion

The surfacing of Ramsay Hunt Syndrome has led to increased awareness regarding this rare disease. As a result, people will be more concerned and will take notice of the initial signs and symptoms of RHS.

If you have had Chickenpox at an early age and are noticing any Ramsay hunt syndrome symptoms, get in touch with us to rule out the possibility of RHS or any other virus-related disease. Our team of doctors at PSRI is proactive in identifying the underlying diseases and symptoms that may lead to further disease development. For more information regarding viral diseases, talk to us today.