Ramsay Hunt & Other Infections

Infections of the facial nerve or in proximity to the facial nerve may affect facial nerve function resulting either in temporary impairment or, in some cases, permanent damage to the nerve. These infections can be caused by viruses or bacteria; among the more known infectious entities causing facial palsy are Ramsay Hunt syndrome, Lyme disease, and middle ear infections (otitis media).

Dr. Shai Rozen, a thought leader in facial paralysis surgery, and a team of leading neurotologists and neurosurgeons at the University of Texas Southwestern Medical Center have helped many people overcome facial paralysis caused by infection. They hope to empower you by providing knowledge about these conditions and understanding the importance of early consultation and sometimes intervention. In most cases when recovery is not observed, early treatment optimizes recovery.

Ramsay Hunt & Other Infections
 Before & After Photos

Case: 1 of 4
Before and 5 months after selective neurectomies of the facial nerve and myectomies
Before and 5 months after selective neurectomies of the facial nerve and myectomies
Case: 1 of 3

Smile and lower lip restoration in a patient with synkinesis with a combination of selective neurectomies and myectomy of the lower lip, performed by Dr. Shai Rozen in Dallas, Texas. Patient presented 6 months after an event of facial paralysis which was diagnosed as Ramsay Hunt Syndrome. She had difficulty with speech, eating, drooling, smil... Read More

Before and 3 years after a free functional gracilis muscle transplant for smile reanimation.
Before and 3 years after a free functional gracilis muscle transplant for smile reanimation.
Case: 2 of 3

Smile restoration with a free functional muscle transplant performed by Dr. Shai Rozen in Dallas, Texas to restore smile and facial symmetry in addition to Botox®️around the right eye for blepharospasm and underlying synkinesis. Patient presented several years after a bout of facial paralysis due to Ramsay-Hunt Syndrome and had difficulty with... Read More

Before and after selective myectomy of the lower lip
Before and after selective myectomy of the lower lip
Case: 3 of 3

Smile and lower lip restoration in a patient with synkinesis with myectomy of the lower lip, performed by Dr. Shai Rozen in Dallas, Texas. Patient with recurring events of facial paralysis presented 16 years after a last event of facial paralysis which was diagnosed as Ramsay Hunt and evolved from flaccid facial paralysis to synkinesis. She h... Read More

Keep in mind that each patient is unique and your results may vary.

Ramsay Hunt Syndrome Type 2

Ramsay Hunt syndrome, named after famous early 20th-century American neurologist James Ramsay Hunt, is a rare condition caused by a reactivation of the virus that causes chickenpox called the varicella-zoster virus (VZV). Patients suffering from Ramsay Hunt often remember having chickenpox as children.

How does Ramsay Hunt syndrome present?

The symptoms of Ramsay Hunt vary. In its classic description, the facial palsy is accompanied by a blister-like rash (erythematous vesicular rash) on the ear (zoster oticus) or in the mouth. Other signs and  symptoms that present in varying degrees include:

  • Nausea
  • Ringing in the ears (tinnitus)
  • Hearing loss
  • Spinning sensation (vertigo)
  • Rapid involuntary eye movement (nystagmus)

Does Ramsay Hunt syndrome always cause a rash?

Around 14% of Ramsay Hunt patients develop the rash after facial palsy develops. Some patients never develop a rash in either the ear or mouth but have a significant increase in VZV antibodies or the presence of VZV DNA in the skin of the ear, saliva, middle ear fluid, or blood. These patients have Ramsay Hunt syndrome zoster sine herpete, which is easily confused with Bell’s palsy. In fact, it is very reasonable to think that many patients diagnosed with Bell’s palsy actually have Ramsay Hunt.

Is there a different prognosis for patients with Ramsay Hunt versus those with Bell’s palsy?

While unclear, it is thought that patients with Ramsay Hunt experience more severe facial paralysis than patients with Bell’s palsy and have a more difficult recovery. They can have recurrent events of facial palsy on the same side of the face and sometimes on the other side of the face, probably due to reactivation of the VZV, often experiencing lesser recovery on the recurrent side.

What are the outcomes of Ramsay Hunt syndrome?

Though it is thought that the prognosis of Ramsay Hunt syndrome may be worse than Bell’s palsy, the outcomes vary. Some patients are left with significant paralysis, others nearly fully recover, and some develop different degrees of synkinesis (uncontrolled facial movements). Treatments, which depend on the degree of recovery, are discussed on the Facial Paralysis Treatments and Synkinesis Treatments pages.

Dr. Rozen in scrubs posing in the operating room
Facial Paralysis Surgeon

Dr. Shai Rozen

Dr. Rozen is a board-certified plastic surgeon who co-created a facial paralysis specialty group with colleagues from otolaryngology & neurosurgery at the University of Texas Southwestern Medical Center.

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Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and, rarely, Borrelia mayonii. It is transmitted to humans through the bite of infected black-legged ticks. Though Lyme disease can occur anywhere in the United States, it is most common in the Northeast, Middle Atlantic, and East North-Central states, which have high populations of deer with infected ticks.

What are the symptoms of Lyme disease?

The initial symptoms of Lyme disease include:

  • Fever
  • Headache
  • Fatigue
  • Characteristic skin rash often shaped like a bull’s eye (erythema migrans)

How is Lyme disease associated with facial paralysis?

Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. If left untreated, the infection can spread to the joints, heart, and nervous system. Injury to the facial nerve can cause facial paralysis.

Is Lyme disease preventable?

People can prevent Lyme disease by using insect repellent, removing ticks promptly, and trying to avoid areas where there are ticks. If you experience a fever, chills, headaches, fatigue, swollen joints, and a rash, early antibiotic treatment is essential. If facial paralysis occurs, you should initially see a neurologist or your primary care physician to be evaluated for Lyme disease.

What happens if Lyme disease causes facial paralysis?

Most cases of facial paralysis from Lyme disease resolve if treated with antibiotics. However, if after 3 months you do not have any facial function or have weak facial function, it is advisable to see a surgeon with considerable expertise in the facial nerve. Though improvements may occur after 3 months, having a discussion and appropriate follow-up with a dedicated facial nerve surgery specialist may provide you with a better understanding of facial paralysis and establish a treatment strategy if necessary.

A Valuable Resource for Those Affected by Facial Paralysis

If you, a loved one, or a patient is affected by facial paralysis, it’s crucial to have accurate, up-to-date information about symptoms and solutions. Board-certified plastic surgeon Dr. Shai Rozen, a specialist in facial paralysis and facial aesthetics, created Your Guide to Facial Paralysis & Bell’s Palsy to be a readily accessible resource for all.

This downloadable, printable e-book makes it easy to understand:

  • How paralysis affects the face
  • When it’s time to see a specialist
  • Common causes of facial paralysis
  • The difference between facial paralysis and Bell’s palsy
  • Myths and facts
  • The latest treatment options
  • Answers to common questions

Get your free copy today—to download or view in your web browser—by completing the following fields:

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Your Guide to Facial Paralysis & Bell's Palsy

Middle Ear Infections

The middle ear is the area of the ear extending from the eardrum to the outside of the oval window of the inner ear. It contains 3 small ossicles (bones) that assist the eardrum in transferring vibrations into waves in the fluid and membranes of the inner ear, resulting in hearing.

How can a middle ear infection (otitis media) cause facial paralysis?

Because the facial nerve is very close to the middle ear as it travels within the petrous bone (inside the skull), any infection in the area can affect the nerve if left untreated. Mild middle ear infections may respond to antibiotics, but more severe cases may need drainage performed by an experienced otolaryngologist. Excessively aggressive cleaning of the middle ear by an untrained practitioner may also cause facial paralysis in rare cases.

If facial paralysis occurs after a middle ear infection or its treatment, what should be done?

The most important steps are to treat the infection and see an experienced otolaryngologist. If the facial paralysis does not resolve within 3 months, consider seeing a facial nerve expert. Dr. Rozen has found it beneficial to establish an initial relationship with patients to increase their knowledge about facial paralysis and develop a future treatment strategy in case it’s needed.

Next Steps

Dr. Rozen and his team understand the distress facial paralysis causes patients and their loved ones. For guidance, information, and the latest treatments available, request a consultation to meet with Dr. Rozen at UT Southwestern.