Acute facial palsy requires urgent medical workup, such as an emergency department or urgent care clinic, to rule out potential life threatening conditions such as a stroke; patients should start appropriate medical therapy as soon as possible.
Ramsay Hunt syndrome is also called herpes zoster oticus. It occurs when the same virus that causes the chickenpox, Varicella zoster, affects the facial nerve. Usually, three things happen when somebody has Ramsay hunt syndrome. First, they develop a single chicken pock or a group of pox or vesicles, right outside the opening of the ear canal, and sometimes inside the ear canal, on the ear itself, or even on the ear drum. Second, they experience acute onset facial paralysis on the same side as the outbreak. Finally, they experience either hearing loss, dizziness, or some combination thereof. These latter symptoms are caused by viral effects on the eighth cranial nerve, the nerve responsible for both hearing and balance.
Occasionally, somebody experiences the facial weakness and the hearing or dizziness symptoms, without any skin outbreak. This condition is referred to as zoster sin herpete, but is essentially treated in the same way.
The biggest difference between Ramsay Hunt syndrome and Bell’s palsy is that in Ramsay Hunt syndrome, usually the external ear hurts, can develop redness, or is tender when it is touched or manipulated. In Bell’s palsy, while many people have some kind of pain in or around the ear, the pain is not triggered by actual movement or manipulation of the ear.
Ramsay Hunt syndrome arises in somebody who has already had the chickenpox, and simply represents reactivation of the virus, much like somebody would get shingles somewhere else in the body. It is likely that shingles vaccination will decrease the likelihood of people developing Ramsay Hunt syndrome, though this has yet to be proven. The condition is treated with both steroids and antiviral medications, but usually is somewhat more severe and it takes longer for the facial paralysis to recover. In extremely rare cases, people do not experience meaningful recovery, and require facial reanimation procedures to bring back facial movement. Much more commonly, people recover, but to an over-recovered state where the face is too tight, and they require the same kinds of interventions that people with Bell’s palsy do. Physical therapy, Botox injections, and minor office procedures can be very effective at resolving these symptoms.