If you follow the media, especially in regards to celebrities you may have heard that Canadian singer Justin Bieber was recently diagnosed with Ramsay Hunt and will have seen that his smile seems a bit off. He is not the only celebrity to develop a facial paralysis. Angelina Jolie, George Clooney, and Pierce Brosnan all developed facial paralysis, but they had Bell’s Palsy which is different than Ramsay Hunt and we will compare the two conditions below.  

So, what exactly is Ramsay Hunt? Well, Ramsay Hunt or herpes zoster oticus is a neurological condition caused by a virus that affects the nerves on one side of the head. If someone has this condition, the two main findings include:

  • Painful shingles rash on the eardrum, ear canal, earlobe, tongue and roof of the mouth on the affected side. 
  • Paralysis of the side of the face that is affected. This will present with difficulty closing the eye, eating with that side of the face, and with making facial expressions.

Other findings may include:

  • Ear pain
  • Hearing loss on the affected side
  • Tinnitus (ringing of the ear)
  • Vertigo/dizziness
  • Impaired ability to taste
  • Dry mouth and eyes
Why Ramsay Hunt syndrome occurs?

Once someone has chickenpox and recovered, the virus stays in their body. Sometimes it reactivates years later and affects the facial nerve and sometimes some of the other (CN V, VIII, IX, X, and X11) nerves around the ear. Here the virus causes swelling that irritates and can temporarily choke the nerve/s. This causes the signs and symptoms outlined above. Stress, chemotherapy, immunocompromise, infection, malnutrition, and others causes increase the risk of onset.

How is Ramsay Hunt diagnosed?

Besides the signs and symptoms we already outlined, testing may include the following:

  • Blood tests
  • Electromyography
  • MRI
  • Nerve conduction studies 
  • Skin tests for the varicella-zoster virus

These tests generally take time to perform and should not delay the initial treatment.

Will Ramsay Hunt Syndrome go away?

A common question is, will it get better? The simple answer is YES, but like most other neurological conditions where nerves are compressed for a period of time there is a spectrum as to how much recovery should be expected. Many recover completely in a few weeks. Some, however, never fully recover and continue to have facial weakness, hearing loss, and/or postherpetic neuralgia. Compared to Bell’s palsy where over 90% regain near normal facial function, 70% regain near normal facial function with Ramsay Hunt. [source]

Ramsay Hunt Management

Management depends on the signs and symptoms involved. Medication such as steroids are usually prescribed. Antiviral medication and pain killers may also be prescribed. 

If the eye does not close completely, an eye patch may be used to protect the eye. Eye drops may also be used. 

Vestibular therapy is recommended if there is any dizziness or unsteadiness and persists after several days. 

It is important to note that the prognosis is improved with early intervention, within days.


Being vaccinated for chickenpox reduces the chance of being infected and the shingles vaccine for seniors is also recommended. 

Other odds n ends
Is Ramsay Hunt syndrome contagious?

No, but it can cause chickenpox in those who have not had chickenpox or been vaccinated for it. 

Are Ramsay Hunt and Bell’s palsy the same?

No. These two conditions are very similar, especially with how it affects facial expression. Bell’s palsy, however, only affects the facial nerve (CN VII), so there is no rash, dizziness, etc. The exact cause is also unknown. 

Ramsay Hunt vs shingles

These are the same thing where the shingles virus affects the facial nerve and possibly the other nerves near one of the ears. 

Ramsay Hunt vs trigeminal neuralgia

Trigeminal neuralgia is due to pain coming from the trigeminal nerve (CN V). So, there are no other signs and symptoms like a rash, facial weakness, or dizziness. The pain is often described as stabbing, lancinating, or a severe electrical sensation. It can occur spontaneously, but is sometimes associated with facial trauma or dental procedures. 

Does Gordon Ramsay Hunt?

Not sure.


We hope that this sheds some light on some of the different causes of facial pain and weakness that can be associated with ear symptoms and dizziness. 

Stealing some lines from Justin Bieber, we hope that we were able to give some “Honest” background on Ramsay Hunt and it is no longer a condition of “What Do You Mean”. 

That being said we wish Justin all the best with his recovery.