A Shingles Complication That Can Damage Hearing

A Shingles Complication That Can Damage Hearing

When the shingles virus invades the facial muscles, it's called Ramsay Hunt Syndrome and it can cause hearing loss and facial weakness.

Ramsay Hunt Syndrome, also known as herpes zoster oticus, is a complication of shingles infection that affects facial muscles and the inner ear.

Shingles is the result of the reactivation of varicella zoster, the virus responsible for chickenpox. The varicella virus that caused your chickenpox can travels back up the nerve fibers and into the skin years later causing the rash, itching, and pain associated with shingles.

Ramsay Hunt Syndrome Symptoms

In Ramsay Hunt Syndrome, the varicella zoster virus spreads to facial nerves. It typically occurs in shingles cases where the rash has spread into or near the ear, resulting in symptoms that are different from those of a typical shingles outbreak.

Ramsay Hunt symptoms include:

  1. Loss of hearing, but only in one ear
  2. Tinnitus, or abnormal sounds occurring in one ear
  3. Intense pain in one ear
  4. Dizziness or vertigo, including the sense of the room spinning around you
  5. An itchy, burning, painful rash that runs over the ear, face, neck, scalp, tongue, or roof of the mouth
  6. Loss of taste sensation in your tongue
  7. When the varicella zoster virus infects your facial nerve, it may result in weakening of the facial muscles, causing another Ramsay Hunt symptom: You might have trouble closing one of your eyes, or find that your smile appears crooked. You also may experience complete paralysis of your facial muscles.

Ramsay Hunt Syndrome Diagnosis

Shingles itself is easily diagnosed. The disease causes very specific types of skin sensations as well as a blistering rash that runs along only one side of the body. Many doctors can diagnose shingles after asking a few questions and performing a simple physical examination.

Because there is not usually a telltale Ramsay Hunt symptom, the syndrome can be harder to diagnose. As part of their examination, doctors might:

  • Examine the skin in and around the ear for shingles rash
  • Examine the facial muscles and nerves for signs of weakness
  • Take a blood test that can look for the presence of the varicella zoster virus
  • Perform a nerve conductance study to determine how badly the facial nerves have been damaged, and whether they will be able to recover
  • Call for an MRI scan to look for facial nerves that have become swollen, which will let them know where the infection has spread
  • Treatment for Ramsay Hunt Syndrome

The same types of antiviral medications used to treat shingles outbreaks are used for Ramsay Hunt Syndrome. Patients normally receive a round of antiviral treatment using drugs such as Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir)for a period of 7 to 10 days.

These drugs do not kill the virus, but halt its spread so the immune system can have a chance to recover and fight back. To help manage symptoms of Ramsay Hunt Syndrome, doctors might also prescribe steroid therapy.

If a person’s facial muscles do weaken and an eye doesn’t close completely, then he will need to wear an eye patch to keep debris from getting into the eye and causing corneal injuries.

What to Expect With Ramsay Hunt Syndrome

Like most illnesses, Ramsay Hunt Syndrome affects different people differently. The prognosis depends on the severity of the nerve damage. If the damage is minor, you may completely recover within a few weeks. If the damage is more severe, you may not regain all sensation and movement that you had before. For the best chance of a complete recovery, it’s important to seek treatment promptly. If you have — or have recently had — shingles and you begin to notice ear pain or abnormal sounds in your ear, or a shingles-like rash on your ear, face, neck, or head, talk to your doctor right away. Early treatment is the best treatment.

Herpes zoster lesions, trigeminal nerve, mandibular branch (CN V3), left side.
Subject is a 33 year old Asian male whose immune system was temporarily weakened by travel stress and jet lag.
First symptoms manifested were trigeminal neuralgia, left side only, followed two days later by herpetic vesicles on lower lip and chin, then cheek, external ear and auditory canal, and scalp around ear.
These photos of erupting herpetic vesicles were taken one week into involvement.