For Providers
This section offers clinical information and treatment insights to support providers caring for patients with Ramsay Hunt syndrome. Explore evidence-based overviews of RHS, current treatment options, and practical guidance to improve patient outcomes and multidisciplinary collaboration.
What is Ramsay Hunt Syndrome?
Ramsay Hunt Syndrome, also known as herpes zoster oticus, is a leading cause of facial paralysis caused by reactivation of the varicella zoster virus (aka the chicken pox virus) affecting the facial nerve. The classic presentation of Ramsay Hunt Syndrome includes sudden onset (within 24-72 hours) facial paralysis, a blistering rash of the ear, and hearing loss and/or dizziness. Some patients will experience facial paralysis and hearing loss or dizziness without ever getting a rash (aka zoster sine herpete). The main distinguishing features between Bell’s palsy and Ramsay Hunt Syndrome include:
-
A painful blistering rash of the ear is consistent with Ramsay Hunt Syndrome
-
“Room spinning” dizziness is consistent with Ramsay Hunt Syndrome
-
While Bell’s palsy patients often have discomfort around the ear, this pain is not triggered by touch or manipulation of the ear like the pain of Ramsay Hunt Syndrome. The pain of Ramsay Hunt Syndrome is more severe than that of Bell’s palsy.
-
While patients with Bell’s palsy and RHS frequently have sensitivity to loud noises, hearing loss is consistent with Ramsay Hunt Syndrome
​​
Treatment Options
Initial Treatment
Recommend starting treatment upon initial evaluation of the patient. Best outcomes are noted when treatment is started within 72 hours of initial symptom onset.
​
For all patients:
-
Steroids
-
60 mg of Prednisone daily for 7-10 days
-
-
Antivirals
-
1000 mg Valtrex TID for 7 days
-
-
Refer to Otolaryngology as well as
Vestibular Therapy and Mental Health Therapy, as needed.
For patients with incomplete eye closure:
-
Eye Protection
-
Drops (ex: Refresh Tears) Q2H and PRN
-
Eye ointment (ex: Refresh PM) nightly
-
Night time care: patients should be instructed to place ointment in the eye, physically close the eye and then tape the upper eyelid to the upper cheek to keep the eye lubricated and closed while asleep.
-
-
For those with a red or irritated eye - consider referral to ophthalmology
Self-Help: https://www.facialpalsy.org.uk/support/self-help-videos/
​
Additional Resources
- Facial Palsy UK - https://www.facialpalsy.org.uk/causesanddiagnoses/ramsay-hunt-syndrome/ has more helpful information on RHS and recovery approaches-
​
Living Rare Study: LivingRareStudy.org (http://livingrarestudy.org/?fbclid=IwZXh0bgNhZW0CMTAAAR3WFRaCtcE3yumj4sFF6rD_s5nSd5fAXXWkPeVczsa9mDKb9YJRORqecIk_aem_yeXOq8Cd7d10R3O4zu1ZvQ)
​
- Questions about the Shingrix vaccine: https://us.gsk.com/en-us/media/press-releases/new-long-term-data-show-shingrix-continues-to-provide-high-protection-against-shingles/
​
- Optimizing the medical management of idiopathic facial paralysis: Michael J. Reilly, M.D., Georgetown University, American Academy of Facial Plastic Reconstructive Surgery (AAFPRS) Annual Meeting 2021. https://www.youtube.com/watch?v=HFhjy6QOEKg
​
- Fix My Face: Expert Advice for Maximizing Recovery from Bell’s Palsy, Ramsay Hunt Syndrome, and Other Causes of Facial Nerve Paralysis, by the Foundation for Facial Recovery, available where books are sold.
- The Hunt for My Smile: Stories of people who lost their smile to facial paralysis, and their journey to find it again, by Amy Sameck, available where books are sold.
​
- Lightkeepers: The Power of Becoming Safe Harbour in the Mental Health Crisis by Mike Shoreman- We are excited to share with you the Facial Paralysis Information Bot.
Click here to start the bot: https://m.me/110403753934092.