Justin Bieber’s Facial Paralysis Virus – What is Ramsay Hunt Syndrome?

Justin Bieber reveals he has Ramsay Hunt Virus

Recently, pop star Justin Bieber has been in the news explaining his partially paralysed face. He explained that his face was paralysed due to a viral condition named Ramsay Hunt Syndrome in a Youtube video. It is the same virus that causes chicken pox and shingles.

To be exact, he said: “the nerve in my ear, facial nerves and has caused my face to have paralysis. You can see this eye is not blinking. I can’t smile on this side of my face. This nostril will not move.”

Justin Bieber has Facial Paralysis Due to Ramsay Hunt Syndrome

Ramsay Hunt syndrome is a neurological disorder. It is a rare condition that happens when the varicella-zoster virus infects the nerve inside your head (positioned very close to the inner ear). We often get chicken pox as a child or sometimes as adults. The virus can lay dormant in the body. In some cases, the virus reactivates itself and produces symptoms of Ramsay Hunt. The Varicella zoster virus is one of the nine known herpes viruses known to infect humans. It is the cause of both chickenpox and shingles when it affects sensory nerves close to the skin. In Ramsay Hunt syndrome it affects the facial nerve which moves the muscles of facial expression.

Some of the common symptoms are painful rash inside your ear canal, outside the ear canal, roof of the mouth, or the tongue.  As the inner ear is involved, individuals with conditions often complain about vertigo or ringing in the ear. Sometimes, it can lead to hearing loss on the affected side of the face. Similar to Justin Bieber, it can lead to facial weakness, droopiness and paralysis on one side of the face.

This weakness on one side of the face will lead to difficulty closing one eye, trouble making certain expressions and food/drinks spilling out of the weakened mouth. The typical treatment involves steroids such as prednisone, they work to minimize inflammation. Pain medication is also important as the condition is usually very painful. Antiviral medicines help with the herpes family such as acyclovir, and valacyclovir.

Bieber fans showed great support for the star and ensured that he is going to get better. Bieber also added that he was doing plenty of facial exercises to get back to normal. He added: “It will go back to normal — it’s just time and we don’t know how much time, but it’s going to be OK. Obviously, my body’s telling me I gotta slow down. I hope you guys understand and I’ll be using this time to just rest and relax and get back to 100%.”

Complete recovery from the condition is not certain. In some cases, patients can recover fully in a few months. The earlier the condition is caught, the better the chances of recovery.

Overview of Ramsay Hunt Syndrome

Ramsay Hunt Syndrome happens when the shingles outbreak affects your facial nerve which moves your facial muscles. Medically the virus is known as Herpes zoster oticus. In addition to painful shingles rash, the condition can lead to facial paralysis and sometimes hearing loss. The condition is caused by the same virus that results in chickenpox. Once chickenpox clears up, the virus will still live dormant, near your nerves. Years later, it can get reactivated. When it does, it will impact your facial nerves.

Quick diagnoses and prompt treatment will minimize the risk of complications that include deafness and permanent facial paralysis.

Symptoms of Ramsay Hunt Syndrome

Key signs and symptoms of Ramsay Hunt syndrome include:

  • Painful rash that is accompanied by fluid-filled blisters typically formed, on, in and around the ears.
  • Facial paralysis in the side of the affected ear.
  • The rash and facial paralysis can occur at the same time or one after the other.
  • In certain cases, the rash doesn’t occur at all.

Other Symptoms

Some individuals also experience ear pain, hearing loss, ringing in their ears, difficulty closing one eye, the sensation of spinning or moving, changes in taste perception, loss of taste, dry mouth and eyes. If you experience any of these, immediately get in touch with a doctor. Early diagnoses will help prevent long-term complications associated with the condition.

Causes of Ramsay Hunt Syndrome

The condition typically occurs in people who have had chickenpox in the past. The virus of chickenpox can stay in your body even when you recover fully. In certain cases, it reactivates itself and leads to a painful rash accompanied by fluid-filled blisters and other serious symptoms as discussed above. If not treated timely, it can lead to permanent facial paralysis on one side of the face as well as hearing loss.

Risk Factors Linked with Ramsay Hunt Syndrome

While the condition can occur in any individual who has had chickenpox in the past, it is found to be more common in older adults. It typically impacts people who are 60 years old or above but can also happen to young individuals. Ramsay Hunt Syndrome is very rare in children.

The facial paralysis syndrome isn’t contagious. However, the reactivated virus can cause chickenpox in people who didn’t have chickenpox in the past and aren’t vaccinated. Infection can be very dangerous for individuals who struggle with immunity problems. Until your rash/blisters aren’t gone completely, avoid having contact with any individual who isn’t vaccinated for chickenpox or hasn’t had them, individuals with weak immunity, children, and pregnant women.

Complications Associated with Ramsay Hunt Syndrome

Serious complications associated with the condition are discussed below:

  • Permanent facial weakness or paralysis
  • Permanent loss of hearing
  • Damage to the eyes can include difficulty closing your eyelid, eye pain and blurred vision (these results are caused by damage to the cornea that is responsible for protecting your eye)
  • Postherpetic neuralgia – A condition that occurs due to damage of confused and exaggerated nerve fibres, leading to pain.

Will my face get better?

If you are treated with antiviral medication within 72 hours if the onset of symptoms then you can expect 70% chance of a full or nearly full recovery, If you are in the unlucky group that do not make a full recovery or have permanent weakness in your face then you should seek the opinion of a specialist plastic surgeon with experience in dealing with this complex condition. There are a range of options that can help to bring back movement to a paralyzed face but many of those options reduce after 12-18 months.

You also need the care of an eye doctor to keep your eye healthy if your blink is not working.

If the damage to the nerve is mild, then you may have an incomplete facial droop/palsy, this is likely to return more quickly than a complete palsy. If you see some improvement and recover some function early – within a few days or weeks afterwards, this is also an encouraging sign. If there is no recovery at 6 weeks then recovery becomes less likely and you should be referred to specialists who deal with this condition regularly.

How Can Ramsay Hunt Be Prevented?

The only way to protect yourself against this condition is to get children vaccinated against chickenpox. It will minimize their chances of getting infected with the chickenpox virus which has the potential to lead to Ramsay Hunt Syndrome. In adults over 50 years of age, a shingles vaccine is available for prevention.

Exams and Tests for Ramsay Hunt

Ramsay Hunt Syndrome is usually diagnosed by conducting a range  of tests that are aimed at excluding other causes of facial weakness in addition to testing the skin blisters(if present) for the virus:

Some of the tests conducted for diagnosis may include:

  • Blood tests
  • Electromyography (EMG)
  • Lumbar puncture
  • MRI of the head
  • Nerve conduction
  • Skin tests for varicella-zoster virus

Treatment for Ramsay Hunt Syndrome

Immediate treatment for Ramsay Hunt Syndrome will help ease the pain and minimize the risk of long-term complications.  Some of the commonly used medications include:

  • Antiviral Drugs – Drugs such as acyclovir, famciclovir, or valacyclovir are used to combat the herpes varicella zoster (chickenpox) virus.
  • Corticosteroids – Doctors typically give a short regimen of high-dose prednisone. The treatment is aimed at reducing the effects of inflammation and swelling in the facial nerve.
  • Pain Relievers – A lot of individuals experience severe pain associated with the condition and prescription meds are of great help.

Lifestyle Changes and Home Remedies

Apart from medication, the following  can help you feel more comfortable if you struggle with Ramsay Hunt Syndrome:

  • It is important to keep your skin clean at all times if you experience rashes.
  • Make sure to use a cold, wet compress if you are experiencing pain along with the rashes. 
  • Take an over-the-counter pain reliever if you experience discomfort.
  • If the condition has affected one of your eyes, it is important to take the following steps: use eye drops to keep your eyes moisturized, use an eye ointment after consulting your healthcare provider and wear an eye patch to help shut your eye.

Preparing for Your Doctor’s Consultation

The first step is to visit your family doctor. He/she might refer you to a specialist which typically is a neurologist or an otolaryngologist.

Prior to your appointment, it is important to note down the following:

  • List of your symptoms and when did they start to appear
  • Whether you are experiencing dizziness or spinning in the room
  • Have you witnessed a change in your hearing capabilities?
  • Has your sense of taste changed in any way?
  • When did you last get a chicken pox vaccine?
  • Are you getting any treatment for your chronic health conditions?
  • Are you pregnant or lactating?

If you are able to answer these questions and have your medical history with you, you are pretty much prepared for your doctor’s appointment.

During your appointment, the specialist will examine your face to note down any signs of one-sided paralysis, look for rashes in and around your ears and might ask you about your symptoms in detail.

The treatment typically resolves around antiviral medications in combination with corticosteroids. Most of the research suggests that starting an antiviral treatment within the first three days of the surgery will have the best outcome. If the treatment is delayed, the risk of permanent facial paralysis and loss of hearing becomes higher.

Any further treatment is specific to the symptoms of the patient. The treatment might involve pain killers, carbamazepine, anti-seizure medicine and vertigo suppressants to help you manage symptoms effectively. It is important to take special care of your eyes as most patients aren’t able to shut their eyes completely which can damage the cornea. Hence, ask your doctor to recommend eye drops, lubricating ointments and eye masks.