Folks who read last week’s column about shingles asked for information about Ramsay Hunt Syndrome. It’s a rare but very debilitating type of shingles, and it can be easily misdiagnosed.
Ramsay-Hunt occurs when the virus that causes shingles lays dormant in nerves of the face, then becomes reactivated. Ramsay Hunt affects only five of every 100,000 people in the U.S. each year.
Like most shingles infections, Ramsay Hunt is characterized by pain and tingling in the area of the affected nerves. This is accompanied by a rash and clusters of fluid-filled blisters. These are typically found around the ear or in the ear canal. If the affected nerves go to facial muscles as well, that side of the face may become paralyzed. The outbreak can mimic a condition known as Bell’s palsy. It is estimated that as many as 20 percent of cases of what appears to be Bell’s palsy are actually unrecognized cases of Ramsay Hunt.
While most patients with Bell’s palsy recover fully, only about half of Ramsay Hunt patients do.
Most patients initially experience pain deep in the ear followed by the rash and blisters. Other signs and symptoms of Ramsay Hunt include hearing loss, ringing in the ears, ear pain, vertigo, slurred speech, altered sensation of taste, walking imbalance and enlarged lymph nodes in the neck.
The diagnosis of Ramsay Hunt requires a doctor who is suspicious in any situation where the condition may be a possibility. The virus can sometimes be cultured, but the process is too slow to be helpful in treating the sufferer. A variety of blood tests are available and can be fairly sensitive but are not foolproof. The virus also can be detected in the tears of up to 25 percent of patients whose faces are paralyzed.
The likelihood of long-term or permanent effects of Ramsay Hunt is significantly reduced if treatment is started within a week of the onset of symptoms and signs of the illness. That’s why it’s so important to identify it early.
Treatment of Ramsay Hunt is similar to that for shingles. Anti-viral drugs, such as Zovirax, can lessen the duration and severity of symptoms. Steroids can be very helpful in reducing the inflammation of the nerves, which also contributes the level of pain and the length of time the outbreak lasts. Anti-anxiety medications and pain medications can play an important role in treatment. In patients with facial paralysis, doctors must take care to prevent irritation and drying of the eye on the affected side, which can lead to corneal ulcers.
Although shingles and Ramsay Hunt have traditionally been regarded as illnesses of older adults, they have been seen increasingly in younger adults and even teenagers. One of the possible explanations is that, ironically, vaccination has created a generation that is in some way more susceptible to shingles later in life. The possibility of Ramsay Hunt makes it even more important for older adults to get the shingles vaccine. Recommendations for younger adults are still unclear.