Ramsay Hunt syndrome: symptoms, treatment and prevention

By Cristiano Antonino On Jun 17, 2022

Ramsay Hunt syndrome, also known as herpes zoster oticus, manifests itself with neurological disorders and is caused by the reactivation of herpes zoster, the same virus that causes chickenpox

It is a treatable condition, but it is important to diagnose and treat it early to avoid major sequelae that then require a long period of rehabilitation.

What is Herpes Zoster

Herpes Zoster is a virus that remains dormant in those who have had chickenpox and that, following a weakening of the immune system or, in the elderly, due to the reduction in immunity typical of age, but also following periods of physical or psychological stress, can replicate:

giving rise to a rash that affects the nerve structures located along the facial nerve;
causing paralysis of one side of the face and alterations or hearing loss in the affected ear.

Pain in the ear and face are characteristic symptoms of this syndrome, sometimes also accompanied by dizziness.

Ramsay Hunt syndrome, symptoms of herpes zoster infection

The most frequent symptoms are:

rash with blisters around the ear or inside the ear canal;
paralysis of the facial muscles on the side of the affected nerve with the inability to furrow the forehead;
ptosis of the eyelid (i.e. drooping eyelid, which may involve one or both eyes)
inability to close the eye;
sloping of the labial rhyme.

Other cranial nerves may be involved with:

onset of dizziness and nausea;
hearing loss;
altered salivation and altered taste.

What are the risk factors

This condition can occur in those who have already had chickenpox because the virus is reactivated due to several factors.

The main ones are:

weakening of the immune system
reduced immunity due to age, more frequent after the age of 60;
severe physical or psychological stress.

Contagiousness

The virus is present in the blisters that appear on the skin around the ear and could theoretically be transmitted to a person who

has not had chickenpox
has not been vaccinated for chickenpox.

This is actually a very very rare occurrence also because chickenpox vaccination is now recommended from childhood.

How Ramsay Hunt syndrome is treated

Therapy is generally based on the combination of:

active antivirals, against Varicella-Zoster virus replication;
corticosteroids to reduce pain, promote vesicle healing and reduce inflammation and oedema around the nerves involved.

The vaccine for prevention

Today it is possible to prevent reactivation of the Herpes Zoster virus

in people over 50;
in younger people with risk factors.

We have a new recombinant, adjuvanted vaccine that can also be offered to immunocompromised patients and is effective in reducing the risk of reactivation of the virus and in reducing the risk of post-herpetic neuralgia, a complication that impacts on quality of life.

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