Home / Conditions / Ramsay Hunt syndrome
Shingles affecting the facial nerve beside one ear, causing a painful rash and weakness or paralysis on that side of the face. How well it recovers depends largely on how quickly treatment starts.
Antiviral treatment started within 72 hours of symptoms appearing gives the best chance of full recovery. Beyond that window, facial weakness and hearing loss are more likely to become permanent.
Go to a doctor the same day if you have:
This is not usually an emergency department matter. Call us on +65 8849 0677 today — there is time to be seen here and started on treatment within the window.
Ramsay Hunt syndrome happens when shingles affects the facial nerve close to one of your ears. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. You may also see it written as herpes zoster oticus, which is the same thing: herpes zoster is the medical name for shingles, and oticus means of the ear.
If you have had chickenpox, the virus never fully leaves. It stays dormant in nerve tissue and can reactivate decades later, usually when the immune system is under strain. When it reactivates in the nerve supplying the face and ear, the result is Ramsay Hunt syndrome.
Unlike shingles elsewhere on the body, its position matters a great deal. The facial nerve controls the muscles of expression, and it runs close to the structures of hearing and balance — which is why this particular site produces paralysis, hearing loss and vertigo rather than only a rash.
The two defining signs are:
They usually appear together, but not always. One can precede the other by days, and in some cases the rash never appears at all — which is a common reason the diagnosis is missed or delayed.
The rash itself changes over the course of the illness. It typically begins as a cluster of small fluid-filled blisters on the outer ear or in the ear canal, which then break, weep and crust over. By the time many people seek help it looks less like blisters and more like a raw, crusted patch — so do not rule it out because what you have does not match a textbook photograph.
Alongside those, you may have:
Both cause sudden one-sided facial weakness, and Bell's palsy is far more common — which is why Ramsay Hunt is sometimes treated as Bell's palsy at first. The distinction matters because Ramsay Hunt needs antiviral treatment and tends to recover less completely.
| Ramsay Hunt syndrome | Bell's palsy | |
|---|---|---|
| Rash | Blisters on or around the ear, usually | None |
| Pain | Often severe ear pain | Mild or absent |
| Hearing | Can be affected, with tinnitus | Usually normal |
| Balance | Vertigo is common | Uncommon |
| Recovery | Less complete on average | Usually good |
| Treatment | Antivirals and steroids, urgently | Steroids |
Because the rash can be absent or late, sudden facial weakness is worth treating as possible Ramsay Hunt until it has been assessed — not the other way round.
If you cannot close the eye on the affected side, it is at real risk. A blink spreads tears across the surface and clears anything that lands on it; without that, the cornea dries out and can be damaged permanently.
This is the part of treatment people most often neglect, because it feels minor beside the paralysis. It is not.
The fluid in the blisters contains live virus. It will not give anyone else Ramsay Hunt syndrome, but it can cause chickenpox in anyone who has never had it and is not vaccinated.
Until the blisters have crusted over, avoid close contact with:
Diagnosis is usually clinical — made from the combination of a painful rash around the ear and one-sided facial weakness, which together are distinctive.
Treatment is generally started on clinical suspicion rather than waiting for test results, because of the 72-hour window.
The acute treatment is medical rather than surgical, and it is urgent.
Antiviral medication together with corticosteroids, started as early as possible. Beginning within three days of symptoms appearing is associated with the best outcomes, which is why this is a same-day problem rather than a next-week one.
Eye protection as above, pain relief, and treatment for vertigo where it is present. Facial exercises and physiotherapy have a part to play as the nerve recovers.
Where the virus has damaged the nerve, pain can continue long after the rash has gone. This is post-herpetic neuralgia, and it happens because damaged nerves send incorrect signals rather than because anything remains infected.
It is often severe, frequently undertreated, and it is squarely within Dr Tung's practice — nerve blocks, pulsed radiofrequency and neuromodulation where medication has not controlled it.
Call us today and we will fit you in. Seventy-two hours is a window, not a countdown in minutes — it is ample time to be seen here, assessed properly by a neurosurgeon and started on treatment. Tell reception it is facial weakness with an ear rash and it will be treated as urgent.
There is a reason to come here rather than anywhere else. Ramsay Hunt affects the facial nerve, the hearing nerve and the balance system at once, and the same consultation can assess all three, confirm it is not something else producing sudden facial weakness, and plan for the complications that follow. Being seen by someone who treats nerves for a living is worth the short wait it takes to get here.
One exception, and it is worth knowing. We are closed on Sundays and from 1pm on Saturdays. If symptoms begin over a weekend and you cannot reach us, do not lose the window waiting for Monday — be seen wherever you can, then come to us afterwards for the follow-through. The treatment is the same wherever it starts; what differs is everything that comes next.
That next part is where most of the long-term difference is made: persistent nerve pain, facial weakness that has not recovered, and ongoing dizziness. Those are the problems people are most often told to live with, and they are treatable.
Most people recover substantially, and those treated within the first three days do best. Some degree of facial weakness or hearing loss can be permanent, particularly where treatment was delayed — which is the whole reason for the urgency.
Yes. The rash sometimes appears days after the facial weakness, and occasionally not at all. Sudden one-sided facial weakness should be assessed promptly regardless of whether there is a rash.
It is shingles, in a particular place. The same virus, reactivating in the facial nerve beside the ear rather than on the trunk — which is what gives it the facial paralysis and hearing symptoms.
Not Ramsay Hunt syndrome itself, but the blister fluid can cause chickenpox in anyone not immune. Avoid newborns, anyone pregnant who has not had chickenpox, and anyone immunosuppressed until the blisters have crusted.
That is post-herpetic neuralgia — pain from nerve damage the virus left behind, rather than continuing infection. It is common, it is often severe, and it responds to treatment aimed at the nerve.
No, you can book directly. If symptoms are happening now, call rather than booking online and say it is facial weakness with an ear rash — there is time within the 72-hour window to be seen here.
Post-herpetic neuralgia · Neuropathic pain · Dizziness and vertigo · Headaches (all types) · Neuromodulation · Neurosurgery
Persistent nerve pain, facial weakness that has not recovered, or ongoing dizziness are all treatable rather than something to accept.
