Herpes Zoster Oticus: Understanding Ramsay Hunt Syndrome and Facial Nerve Paralysis

Ramsay Hunt syndrome, named after the neurologist James Ramsay Hunt, specifically refers to a subtype of herpes zoster oticus accompanied by facial nerve paralysis.

It is characterised by a painful, blistering rash on the ear, the ear canal, the eardrum, and/or the skin around the ear. This condition can cause significant pain and discomfort, along with various neurological symptoms, like hearing loss and specifically, facial palsy or facial paralysis.³

Therefore, while herpes zoster oticus and herpes zoster are related, they are not identical conditions.

The spread of the varicella-zoster virus (VZV) to the facial nerves is what causes Herpes Zoster Oticus.²

Ramsay Hunt syndrome itself is not contagious. However, if you have it, it means you have the varicella-zoster virus which causes herpes zoster.

Active herpes zoster lesions are infectious, and direct contact with vesicular fluid, can spread VZV infection. This causes varicella in people who have never had it or been vaccinated for it. Once varicella resolves, these people would be at risk of developing herpes zoster.⁵

Active herpes zoster lesions should be covered and contact with others avoided, until the lesions are dry and crusted.⁵

Usually, two to four weeks.

Symptoms such as pain, tingling or itching may be present for several days before the rash appears.⁵

Over three to five days, clusters of vesicles form which progressively dry and crust over, healing in two to four weeks. However, pigmentation changes and scarring on the skin may remain permanently.⁵

The varicella-zoster virus (VZV) is the same virus that causes chickenpox during the initial infection. After the resolution of chickenpox, the virus remains dormant in the sensory ganglia of the nerves of the brain and spine.

Herpes zoster oticus, or Ramsay Hunt syndrome, occurs when the VZV reactivates in the geniculate ganglion, a collection of sensory neurons of the facial nerve.⁴

Various factors can reactivate the virus, leading to herpes zoster. These may include:

• Compromised or suppressed immune system
• Aging
• Other underlying medical conditions 

Herpes zoster oticus is a specific manifestation of herpes zoster, commonly known as Shingles.

Herpes zoster refers to the reactivation of the VZV in any part of the body, typically presenting as a painful rash with fluid-filled blisters. When herpes zoster affects the geniculate ganglion and the associated structures, it leads to herpes zoster oticus.⁵

The difference is that Shingles is a painful rash that typically occurs as a stripe around one side of the body. It can also occur on one side of the face, affecting the eye and vision.⁶

Other symptoms may include:
•    Fever
•    Headache
•    Chills
•    Upset stomach ⁶
•    Photophobia (sensitivity to bright light)⁵
•    Malaise⁵

These two conditions are caused by different viruses and have distinct modes of transmission.

Herpes zoster, including Herpes zoster oticus, is caused by the reactivation of the varicella-zoster virus, which primarily causes chickenpox during the initial infection.

Herpes simplex viruses (HSV-1 and HSV-2) are the viruses responsible for genital herpes, which can be sexually transmitted.

Both viruses are able to lie dormant within the body and flare up. Herpes zoster typically only flares up once in a lifetime, while herpes simplex can reoccur often.

Although both cause a rash, a herpes zoster rash usually develops on one side of the body. Conversely, the herpes simplex rash develops in or around the mouth and genitals.

To treat both types, a doctor will prescribe antiviral medications.⁷

No, herpes zoster, including Herpes zoster oticus, is not considered a sexually transmitted disease (STD). It is caused by the reactivation of the varicella-zoster virus, which primarily causes chickenpox during the initial infection.⁷

Early diagnosis and prompt treatment are essential in managing herpes zoster oticus.

Antiviral medications and corticosteroids are commonly prescribed to reduce the severity and duration of the viral infection. For example: 

• Acyclovir-prednisone
• Valacyclovir
• Famciclovir, These medications are most effective when initiated within 72 hours of symptom onset.

Additionally, supportive care measures can alleviate the symptoms associated with herpes zoster oticus. Pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to manage pain.

In cases of severe pain or persistent symptoms, corticosteroids may be prescribed to reduce inflammation and minimize complications.