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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Assessment online. A doctor can recognise Ramsay Hunt syndrome by video and tell you how urgently to be seen; the examination and treatment of facial weakness are in person.
- What it is: shingles affecting the facial nerve near the ear: a painful rash with blisters in or around one ear, and weakness of the face on the same side.
- Timing matters: antiviral treatment, usually with steroids, works best when it starts within 3 days of the first symptoms.
- How common: about 5 in 100,000 people a year, mainly adults over 60; it causes about 12% of facial palsies.
- Emergency: call 112 if facial weakness comes with weakness or numbness in an arm or leg, slurred speech or confusion: these can be signs of a stroke.
Do not book a video appointment if weakness of the face comes with weakness, numbness or tingling in an arm or leg, slurred speech, confusion or a sudden severe headache: call 112 or go to an emergency department. New weakness of the face with ear pain or a rash around the ear needs an examination in person so that treatment can start: get medical advice the same day.
Can an online doctor help with Ramsay Hunt syndrome?
Not fully. Weakness of the face needs an examination in person, of the face, the ear and the eye, and Ramsay Hunt syndrome is treated with antiviral medicine, usually with steroids, which work best when started within 3 days. What a doctor can do by video is recognise the pattern, rule out the signs of a stroke, and tell you how urgently and where to be seen. A painful shingles rash around the ear without any weakness of the face is managed as shingles, and the doctor may start antiviral treatment by video while you watch for the signs that change the plan.
How an online consultation helps with possible Ramsay Hunt syndrome
- Stroke ruled out first: Weakness of the face with arm or leg weakness, numbness or slurred speech means 112, not a video call.
- The clock respected: Treatment works best within 3 days, so you are told plainly where to go and how fast.
- Shingles around the ear treated: A painful rash around the ear without facial weakness can be treated early, before the nerve is involved.
- Recovery supported: Protecting the eye, managing pain, and when to see a facial palsy specialist.
What the doctor checks in an online assessment for Ramsay Hunt syndrome
The doctor asks about the signs of a stroke first, then looks at your face and the ear on camera. The doctor asks about:
- Warning signs: weakness or numbness in an arm or leg, slurred speech, confusion, a sudden severe headache, or changes in vision.
- Your face: when the weakness started, whether you can close your eye, raise your eyebrows and smile evenly.
- The rash: blisters in or around the ear, on the scalp near the ear, or inside the mouth, and how painful it is.
- Your ear: pain, ringing, hearing loss or sensitive hearing, and dizziness.
- Your health: chickenpox in the past, a weakened immune system, diabetes, high blood pressure, pregnancy, and your medicines.
Before the call, sit facing a window or a lamp, and if possible ask someone to hold the camera close to the ear and to your face while you move it.
What is Ramsay Hunt syndrome?
Ramsay Hunt syndrome, also called herpes zoster oticus, is shingles affecting the facial nerve near the ear. The chickenpox virus, varicella zoster, stays in the nerves after chickenpox and can wake up years later as shingles. When it reactivates in the nerve that moves the face, it causes a painful rash around the ear and weakness of the face on the same side, and it can affect hearing, taste and balance.
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| Fact | What the sources say |
|---|---|
| How common | About 5 in every 100,000 people a year |
| Who gets it | Mainly adults, particularly over 60; slightly more common in women; rare in children |
| Share of facial palsies | About 12% of facial palsies, the second most common cause of facial paralysis not caused by an injury |
| Facial weakness before the rash | In about 20% of people |
| No blisters at all | In about 10% of people |
| Treatment window | Antivirals work best when started within 3 days |
Why do people get Ramsay Hunt syndrome?
Anyone who has had chickenpox can get it. The virus is more likely to reactivate when the immune system is weaker, with age, illness, treatments such as steroids or chemotherapy, or HIV, and physical or emotional stress may play a part.
What are the symptoms of Ramsay Hunt syndrome?
The two main signs are a painful rash with fluid-filled blisters in, on or around one ear, sometimes inside the mouth, and weakness of the face on the same side: a drooping corner of the mouth, and difficulty closing the eye. Other symptoms are:
- ear pain, often severe
- ringing in the ear (tinnitus), hearing loss, or sounds that seem too loud
- dizziness or a spinning feeling, sometimes with feeling or being sick
- a watering or dry eye on the affected side
- a change in taste on one side of the tongue, and a dry mouth
- a flu-like feeling, with a high temperature or headache, for a few days before the rash
The symptoms do not always come together. In about 1 in 5 people, the weakness of the face starts several days before the blisters, and about 1 in 10 people never get blisters, which makes it easy to mistake for Bell’s palsy. The rash can look red, purple or brown, depending on skin tone.
Ramsay Hunt syndrome, Bell’s palsy or a stroke?
Sudden weakness of one side of the face always needs assessing, because the causes need different care:
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| Condition | What points to it | What to do |
|---|---|---|
| Ramsay Hunt syndrome | Weakness of the face with a painful rash or blisters around the ear, often severe pain, and ear symptoms | In-person assessment promptly; treatment works best within 3 days |
| Bell’s palsy | Weakness of the face on one side, usually without a rash or severe ear pain | In-person assessment promptly |
| Shingles around the ear | A painful rash around the ear, with no weakness of the face | Antiviral treatment early; watch for facial weakness |
| Stroke | Weakness of the face with weakness or numbness in an arm or leg, slurred speech or confusion | Call 112 now |
Ramsay Hunt syndrome tends to be more severe than Bell’s palsy, and full recovery is less likely, which is why it is treated promptly with antivirals as well as steroids. A test of fluid from the ear can confirm the virus when the picture is unclear.
Is Ramsay Hunt syndrome contagious?
You cannot catch Ramsay Hunt syndrome or shingles from someone who has it. But someone who has never had chickenpox can catch chickenpox from the fluid in the blisters. The virus spreads only while the rash is weeping, so keep the rash covered, and stay away from people who have not had chickenpox until it has dried out.
What might the doctor recommend for possible Ramsay Hunt syndrome?
What happens next depends on whether your face is weak, how long ago it started, and what comes with it. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Facial weakness with arm or leg weakness, numbness, slurred speech or confusion | Emergency care | No | Call 112 now |
| New weakness of the face with ear pain or a rash around the ear | Examination, and antivirals with steroids | Only to assess | Urgently: get medical advice the same day |
| A painful rash around the ear, face not weak | Antiviral treatment as for shingles, and pain relief | Yes | If weakness of the face, hearing loss or dizziness starts |
| An eye that cannot close fully | Eye lubricant and protecting the eye | Partly | For an eye check, and an eye specialist if it is still not closing after 2 to 3 weeks |
| Recovering facial weakness after treatment | Eye care, pain relief and follow-up | Yes | A facial palsy specialist if there is no improvement after a month |
| Pain that lasts after the rash has healed | Assessment of nerve pain | Partly | For nerve pain medicines, which are not prescribed online |
A rash around your ear, or a face that feels weak? A doctor can tell you in one consultation how urgently you need to be seen.
See available times →How is Ramsay Hunt syndrome treated?
Treatment aims to calm the virus and the inflammation of the nerve as early as possible, protect the eye, and control the pain:
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| Treatment | What it does | Good to know |
|---|---|---|
| Antiviral tablets, such as aciclovir or valaciclovir | Slow the virus | Full recovery is more likely when they start within 3 days |
| Steroid tablets | Reduce swelling of the nerve | A short course, usually alongside the antivirals |
| Eye drops, ointment and protection | Keep an eye that does not close properly moist and safe | Preservative-free drops if used often; tape or a patch at night may be advised |
| Painkillers | Ease the ear and face pain | Stronger nerve pain medicines may be needed |
| Specialist facial therapy | Support from a specialist facial therapist | When recovery is slow |
What you can do yourself
- Get assessed promptly: treatment works best within 3 days of the first symptoms.
- Protect the eye if it does not close: use lubricating drops through the day and ointment at night.
- Keep the rash clean and covered, and do not burst the blisters.
- Use a cool pack on the rash for comfort, and take paracetamol for the pain.
- Stay away from people who have not had chickenpox while the rash is weeping.
Prescription treatment
A prescription is never issued without a consultation. When weakness of the face has started, antivirals and steroids are usually started after an examination in person. For a shingles rash around the ear without facial weakness, the doctor may prescribe antiviral tablets, such as aciclovir or valaciclovir, and advise on pain relief and eye protection. Opioid painkillers and nerve pain medicines such as gabapentin and pregabalin are controlled medicines and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Waiting to see whether the weakness goes away by itself. Starting treatment late. Leaving an eye that cannot close unprotected.
Can you fully recover from Ramsay Hunt syndrome?
Many people do, especially when treatment starts early, but recovery is less certain than with Bell’s palsy. Mild nerve damage can recover within a few weeks; more severe damage recovers more slowly and less completely. Recovery is less likely with diabetes, high blood pressure, age over 60, or vertigo, and when antivirals start after the first 3 days.
Possible lasting problems include:
- weakness of the face that does not fully recover
- hearing loss or hearing that stays too sensitive
- unwanted face movements when you move another part of the face, called synkinesis
- ear or face pain that continues after the rash heals (post-herpetic neuralgia)
If there is no improvement after a month, ask for a referral to a facial palsy specialist, and if the eye still does not close after 2 to 3 weeks, to an eye specialist.
Can Ramsay Hunt syndrome be prevented?
Shingles vaccination lowers the risk of shingles and of Ramsay Hunt syndrome, and it is often recommended for older adults and for adults with a weakened immune system. Ask a doctor whether it is right for you.
Special situations
Pregnancy
Shingles in pregnancy needs urgent assessment, so tell the doctor straight away.
A weakened immune system
Shingles with a severely weakened immune system needs urgent assessment. Tell the doctor about any treatment that affects your immune system.
Hearing and dizziness
Hearing loss, ringing or spinning with the rash need checking in person. The hearing loss and tinnitus pages explain the follow-up.
Ramsay Hunt syndrome while travelling in Europe
Do not wait until you get home: the treatment window is short. If your face goes weak on holiday, get seen urgently at a local emergency department or urgent care centre, or call 112 if there are stroke signs, and keep a record of the treatment you were given.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When Ramsay Hunt syndrome is assessed online, and when you need in-person care
Assessed online: recognising the pattern, ruling out the signs of a stroke, deciding how urgently you need to be seen, early antiviral treatment for a shingles rash around the ear without facial weakness, and support during recovery.
In-person care: any new weakness of the face, the examination of the face, ear and eye, starting antivirals with steroids, hearing tests, eye checks, and nerve pain treatment.
When to get in-person care
Call 112 or go to an emergency department now for:
- weakness of the face with weakness, numbness or tingling in an arm or leg
- weakness of the face with slurred speech, confusion or difficulty understanding
- a sudden, severe headache
- severe dizziness with being unable to stand or walk
Get medical advice the same day for:
- new weakness or drooping of one side of the face, even with a rash that explains it
- a painful rash or blisters in or around the ear
- sudden hearing loss
- an eye that cannot close, or eye pain, redness or changes in vision
- a shingles rash near the eye or on the nose
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: say when the rash and any weakness of the face started, show your ear and your face on camera, and mention any change in hearing or balance.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s Ramsay Hunt syndrome? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Earache can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about Ramsay Hunt syndrome
What is Ramsay Hunt syndrome?
Ramsay Hunt syndrome is shingles affecting the facial nerve near the ear. The chickenpox virus reactivates and causes a painful rash with blisters in or around one ear and weakness of the face on the same side, and it can affect hearing, taste and balance.
What are the symptoms of Ramsay Hunt syndrome?
The symptoms of Ramsay Hunt syndrome are a painful rash with blisters in or around one ear, weakness of the face on the same side, ear pain, ringing, hearing loss, dizziness, a dry or watering eye, and a change in taste. The weakness can start before the rash, and some people never get blisters.
How is Ramsay Hunt syndrome treated?
Ramsay Hunt syndrome is treated with antiviral tablets, usually with a short course of steroid tablets, painkillers, and protection for an eye that does not close. Treatment works best when it starts within 3 days of the first symptoms.
What can I do at home with Ramsay Hunt syndrome?
With Ramsay Hunt syndrome, protect the eye on the weak side: lubricating drops by day, ointment at night, tape the eyelid closed for sleep and wear glasses outdoors, because an eye that cannot blink dries out and can be scarred. Take paracetamol or ibuprofen for the pain, keep the blisters clean and do not pick them, and avoid contact with pregnant women, babies and anyone with a weak immune system until the blisters have crusted over.
Can you fully recover from Ramsay Hunt syndrome?
Many people recover fully from Ramsay Hunt syndrome, especially when treatment starts within 3 days. Recovery is less certain than with Bell’s palsy, and it is less likely with diabetes, high blood pressure, age over 60 or vertigo.
Is Ramsay Hunt syndrome contagious?
You cannot catch Ramsay Hunt syndrome or shingles from someone who has it. But someone who has never had chickenpox can catch chickenpox from the fluid in the blisters, while the rash is weeping.
Why do people get Ramsay Hunt syndrome?
Ramsay Hunt syndrome happens when the chickenpox virus, which stays in the nerves after chickenpox, reactivates in the facial nerve. A weaker immune system, with age, illness or some treatments, makes it more likely, and stress may play a part.
How long does Ramsay Hunt syndrome last?
In Ramsay Hunt syndrome, mild nerve damage can recover within a few weeks. More severe damage takes longer and may not recover fully. See a facial palsy specialist if there is no improvement after a month.
Is Ramsay Hunt syndrome the same as Bell’s palsy?
No. Both cause weakness of one side of the face, but Ramsay Hunt syndrome is caused by the shingles virus, usually comes with a painful rash around the ear, tends to be more severe, and is treated with antivirals as well as steroids.
How serious is Ramsay Hunt syndrome?
Ramsay Hunt syndrome is a serious condition because the facial weakness, hearing loss or pain can last if it is not treated early. That is why sudden weakness of the face with a rash around the ear needs assessment in person promptly.
Can Ramsay Hunt syndrome be prevented?
Shingles vaccination lowers the risk of shingles and of Ramsay Hunt syndrome. It is often recommended for older adults and for adults with a weakened immune system.
Can an online doctor treat Ramsay Hunt syndrome?
Not fully. A doctor can recognise Ramsay Hunt syndrome by video, rule out a stroke and tell you how urgently to be seen. Weakness of the face needs an examination in person so that antivirals and steroids can start.
- Ramsay Hunt syndrome, DermNet, New Zealand Dermatological Society, updated 2026.
- Ramsay Hunt syndrome: symptoms and causes, Mayo Clinic (US), updated 22 December 2025.
- Shingles, NHS, National Health Service (UK), reviewed 23 November 2023.
- Ramsay Hunt syndrome, Facial Palsy UK, reviewed 18 September 2024.
- Sudden deafness, NIDCD, US National Institute on Deafness and Other Communication Disorders, updated September 2018.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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