Ramsay Hunt syndrome

Ramsay Hunt syndrome is a reactivation of the chickenpox (shingles) virus affecting the facial nerve near the ear. Its classic signs are a painful rash in or around the ear and weakness on one side of the face, and it can also cause hearing loss, tinnitus and vertigo — so see a doctor urgently, as antiviral and steroid medicines are usually started as early as possible. When the infection damages the inner ear’s balance function, vestibular rehabilitation is strongly supported by clinical practice guidelines to help the brain compensate. At McKelvie Physiotherapy in Pickering, we focus on the dizziness and balance side of recovery, working alongside your medical team.

What is Ramsay Hunt syndrome?

Ramsay Hunt syndrome — also called herpes zoster oticus — happens when the varicella-zoster virus, the virus that causes chickenpox and shingles, reactivates and inflames the facial nerve near the ear.

The classic picture is a painful rash or blisters in or around the ear together with weakness on one side of the face. Because the facial nerve runs close to the nerve for hearing and balance, the infection can also cause hearing loss, tinnitus and vertigo. In some people, the rash appears after the facial weakness — or not at all — which can make it harder to recognize.

What causes Ramsay Hunt syndrome?

After chickenpox, the varicella-zoster virus stays dormant in the body’s nerves. Years later, it can reactivate as shingles. When that reactivation involves the facial nerve near the ear, it causes Ramsay Hunt syndrome.

If the inflammation reaches the vestibulocochlear nerve — the nerve for hearing and balance — or the inner ear itself, it can reduce balance function on that side. That’s what leads to vertigo and lingering imbalance, and it’s the part of recovery that vestibular rehabilitation can help with.

What are the symptoms of Ramsay Hunt syndrome?

• A painful red rash or blisters in or around the ear, or on the roof of the mouth or tongue
• Weakness or drooping on one side of the face
• Ear pain, which can be severe
• Hearing loss or ringing in the ear (tinnitus)
• Vertigo, nausea and imbalance
• Difficulty closing the eye on the affected side, or a dry eye
• Changes in taste

How is Ramsay Hunt syndrome treated?

It’s important to be clear about who treats what.

Medical treatment comes first, and it’s a physician’s job. Your doctor will usually prescribe antiviral medication and corticosteroids (steroids) as early as possible, along with pain relief and advice on protecting the eye. Hearing loss needs medical and audiology assessment, and you may be referred to an ENT specialist. Facial weakness is managed by your medical team; our physiotherapy care focuses on dizziness and balance.

Physiotherapy helps with the balance side of recovery. When Ramsay Hunt syndrome has reduced balance function in the inner ear, vestibular rehabilitation helps the brain compensate. The clinical practice guideline from the Academy of Neurologic Physical Therapy strongly recommends vestibular rehabilitation for people with peripheral vestibular hypofunction (Hall et al., 2022). A program typically includes:

• gaze stabilization exercises to keep your vision clear while your head moves
• balance exercises to rebuild steadiness when standing and walking
• habituation exercises to reduce sensitivity to the movements and environments that provoke dizziness

1. 01

   Assess

   Once your doctor is managing the infection, a full vestibular assessment with infrared video goggles to see how your balance system has been affected.

2. 02

   Rehabilitate

   A personalized program of gaze stabilization, balance and habituation exercises, paced around your pain, fatigue and any ongoing medical treatment.

3. 03

   Rebuild confidence

   Regular re-testing and progressively harder exercises to get you moving confidently again at home, at work and in busy places.

Why choose McKelvie Physiotherapy for Ramsay Hunt syndrome?

• Advanced vestibular expertise — our lead physiotherapist is an Advanced Vestibular Physical Therapist (AVPT), and dizziness is our clinical focus, not a sideline.
• Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
• Accurate, one-on-one assessment — in a private room, with time to get to the bottom of your symptoms.
• Connected care — we work closely with local ENT specialists, so your balance rehab fits with your medical care.
• Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
• Direct billing to many major insurers — and no referral needed.