Ramsay Hunt syndrome type 2

Ramsay Hunt syndrome type 2

Ramsay Hunt syndrome type 2 involves the ear and causes facial nerve paralysis. It is also referred to as herpes zoster oticus due to the varicella zoster virus that causes it. This is the same virus that causes chickenpox.

Ramsay Hunt syndrome type 2
Ramsay Hunt sydrome type 2 with facial nerve paralysis and painful blisters in the ear

The chickenpox virus usually stays dormant in the patient after an infection and many years later it can be reactivated due to stress or illness in the patient. It then manifests as shingles. In Ramsay Hunt syndrome type 2 the virus  attacks the ear and its nerves. It is more common in older patients and luckily rare in children. The syndrome is also more commonly seen in patient’ with immunodeficiency.

Ramsay Hunt syndrome type 2 is a painful condition characterized by blisters in the ear and facial nerve paralysis. Furthermore, it can cause hearing loss, vertigo, disequilibrium, tinnitus, taste disturbance and irritation of the eye on the side of the paralysis. When the zoster virus causes facial nerve paralysis without a rash it is referred to as Zoster Sine Herpete, a condition that may be confused with Bell’s palsy.

Ramsay Hunt syndrome type 2 usually has a worse outcome than Bell’s palsy with incomplete recovery of facial nerve function and sometimes permanent facial nerve weakness. Hearing loss may be permanent and if the eye is damaged it may lead to loss of vision. Patients may sometimes develop post herpetic neuralgia which is a chronic pain syndrome after the infection has cleared.

The sooner the treatment is started, preferably within 3 days, the better. Treatment will usually include anti virals, cortico steroids, analgesics, eye drops, eye protection and in rare cases surgical decompression of the facial nerve.

Children are nowadays vaccinated against chicken pox which reduces the chance of chickenpox (and shingles). Pregnant ladies should avoid contact with patients with chickenpox. A vaccine against shingles are available and recommended for patients 60 years of age and older. The vaccine can also be given for patients who have had Ramsay hunt syndrome type 2 to avoid possible recurrence.