This disorder is caused by the same virus that causes chickenpox and shingles, called the Varicella Zoster Virus (VZV). How it works is that once you get this virus – so say you get chickenpox when you are six years old – the virus stays and lives in your nerves lifelong and can reactivate years later; when the virus reactivates, this presents as a shingles outbreak.
Physiological symptoms include:
- Facial paralysis
- Hearing loss
- Rash with blisters
- Loss of taste
- Drooping/sagging face
What is going on behind the scenes is the virus is in the seventh and eighth cranial nerves. Specifically, it starts with the Geniculate Ganglion, which is a cluster of nerve cells that are physically located near the facial nerve (which is cranial nerve 7) and also in the bony facial canal near the ear.
VZV lives dormant in the geniculate ganglion, and can be reactivated for a variety of reasons, high stress and a weaker immune system being two main causes. When the virus reactivates, the virus travels along nerve fibers and causes inflammation. This turns into intense swelling around the geniculate ganglion, which as mentioned before is a dense cluster of cells, so it is a confined space, which causes the swelling to compress the facial nerve.
The compression prohibits the transmission of electrical signals between the brain and the facial muscles, thus causing facial paralysis.
To explain a little bit about cranial nerve 7’s role, it carries motor and sensory signals where
- Motor fibers control muscle movement, and
- Sensory fibers transmit taste sensations
So, this explains why damage to the facial nerve results in paralysis and altered taste.
One branch of cranial nerve 7 is the nervus intermedius, which carries parasympathetic fibers that control autonomic body functions, specifically tear production and salivation.
Normally, parasympathetic fibers stimulate the lacrimal glands, which are located atop the outer corner of each eye; these glands are what usually produce tears that keep eyes moist, free from debris, and lubricated. The facial nerve also is what allows you to close your eyelids, so your eyes are at risk when they are continuously left open, which is why many patients wear eye patches or have to tape their eyes shut with medical gauze.
A symptom of Ramsay Hunt is reduced tear production, which causes dry eyes, which further leads to blurry vision, irritation, and a high risk of eye infections.
It is also possible – and in my mom’s case, this did happen – for the virus to spread to the vestibulocochlear nerve, also known as cranial nerve 8, which is responsible for hearing and balance.
When this swelling also spreads to CN8, it can lead to vertigo, tinnitus, and hearing loss.
Vertigo is caused when cranial nerve 8 is inflamed which disrupts normal signal transmission, leading to a disruption of the normal balance. More specifically, these mismatched signals about movement and position results in the brain receiving conflicting information, which results in spinning and dizziness.
Tinnitus, also known as ringing in the ear, is caused by the cranial nerve 8 swelling that disrupts normal auditory signals. The swelling damages cochlear nerve fibers which are responsible for transmitting sound information from the cochlea (inner ear) to the brain for processing. Within the nerve, there is then abnormal electrical activity, which the brain interprets as a ringing.
If Ramsay Hunt is left untreated, the prolonged inflammation coupled with the viral activity leads to the degeneration of nerve fibers which essentially means permanent nerve damage.
Because of our body’s natural immune response to viruses, it ends up actually contributing to the inflammatory process around affected nerves, resulting in prolonged dysfunction.
As for treatment options, first and foremost is getting vaccinated–generally speaking the shingles vaccine is anywhere from 88-97% effective. Ramsay Hunt generally heals by itself over the course of months to years, but it doesn’t always fully heal and patients may always have facial paralysis or other symptoms.
To learn more, visit
Ramsay Hunt syndrome | Journal of Neurology, Neurosurgery & Psychiatry
Ramsay Hunt Syndrome: An Introduction, Signs and Symptoms, and Treatment – PMC