You likely experienced Ramsay Hunt syndrome (RHS), a complication that comes from prior infection with the varicella-zoster virus (VZV), which also causes chicken pox and shingles. Once you are infected with VZV, the virus can lie dormant for decades in structures of the human nervous system such as the cranial nerves (which mostly emanate from the brainstem at the bottom portion of the brain) and clusters of nerve cells just outside of the spinal cord.
The virus can then be reactivated under conditions of stress or reduced immune function. This is known, in general, as shingles, especially when it results in a painful, blistery rash in a stripe-like pattern on the torso. RHS is a subset of shingles that snarls a specific nerve in the face, known as the facial nerve or cranial nerve VII.
Symptoms of RHS
The first symptom is usually pain in the ear and one side of the face. That is followed by blistery-appearing lesions and, of particular concern, paralysis of the facial nerve of varying severity and duration. This paralysis makes itself known in the form of an asymmetry on one side of the face (with the cheek and mouth dipping below the other side), along with difficulty in smiling and partial loss of taste. Some people also experience ringing in the ear, hearing loss, dizziness, and dry eyes.
RHS eventually resolves on its own, with full or at least partial restoration of function. Full resolution occurs in 70 percent of RHS cases. In Bell’s palsy, a much more common form of facial nerve paralysis, full resolution of the symptoms occurs in 90 percent of cases.
Treatment is designed to mitigate symptoms and, where possible, to reduce the load of the virus that causes the disorder. The latter is achieved with common antiviral drugs used for the herpes family of viruses, including acyclovir or valacyclovir or, in some cases, famciclovir, for at least a week. A doctor may also prescribe corticosteroids. Artificial tears and eye drops can be helpful in some cases, while patients with more severe or persistent symptoms may require more intensive follow-up by a physician and care team.
Painkillers are a basic part of management. If over-the-counter analgesics like acetaminophen, aspirin, or ibuprofen are insufficient, a physician might prescribe stronger painkillers and, in some cases, a drug like gabapentin, which is used for neuropathic pain involving the affected nerves (especially in the event of postherpetic neuralgia, a painful complication of shingles or RHS).
While prevention is difficult to guarantee, patients obtaining the shingles vaccine are at reduced risk of RHS as well. Steer clear of anyone with an active chicken pox infection (since the virus is spread through a respiratory route or by saliva or mucus), and be careful around anyone with an existing case of shingles or RHS, since the vesicles also contain active virus particles.