• Justin Bieber announced he was diagnosed with Ramsay Hunt syndrome after cancelling multiple shows on his tour.
  • The neurological disorder impacts the nerves of the face, often causing paralysis and a rash.
  • Experts say it could take months for a full recovery depending on the severity of symptoms.

Justin Bieber recently announced on his Instagram that he is suffering from a rare condition called Ramsay Hunt syndrome. After postponing multiple shows on his tour due to a non-COVID-19-related illness, the pop star shared his diagnosis with fans.

“It is from this virus that attacks the nerve in my ear and my facial nerves and has caused my face to have paralysis,” Bieber said in a video. “As you can see, this eye is not blinking. I can’t smile on this side of my face. This nostril will not move.”

We had experts break down what exactly Ramsay Hunt syndrome is, and how long it will take for the Peaches singer to hit the stage again.

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What is Ramsay Hunt syndrome?

Ramsay Hunt syndrome is a rare neurological disorder that impacts your ear, mouth, and nerves in your face. The syndrome occurs from the varicella zoster virus, which is the same virus that causes chickenpox in children and shingles in adults.

It is also sometimes referred to as the herpes zoster oticus, because of the ear rash that often accompanies the syndrome. 

Ramsay hunt syndrome can sometimes be confused with Bell’s palsy which also produces stroke-like symptoms. This neurological disorder of the facial nerve is often characterised by the sudden onset of facial paralysis, fever, pain behind the ear, stiff neck, and weakness in the face. Bell’s palsy can be related to a similar virus but is not from the varicella zoster virus.

What causes Ramsay Hunt syndrome?

The varicella zoster virus can live dormant in your body and infect the facial nerve near the inner ear, leading to irritation and swelling of the nerve, known as Ramsay Hunt syndrome, according to Mount Sinai. Typically a period of stress, fatigue, and immune suppression can reactivate this virus years after coming in contact with chickenpox, says Dr Amit Kochhar, an ear, nose and throat specialist. 

All genders are equally impacted by Ramsay Hunt syndrome, which is estimated to occur in five out of every 100,000 people a year in the United States, according to NORD. In comparison, Bell’s palsy impacts 15 to 30 per 100,000 people per year. It is most common in adults over 60 and can occur in anyone who has had chickenpox.

Symptoms of Ramsay Hunt syndrome

Symptoms can vary person-to-person, but it most often causes pain behind the ears, a rash on the ear or face, and potentially hearing loss and facial paralysis, Dr Kochhar says. As the nerve in the face gets inflamed, it expands and grows. The bone, which usually acts as a tunnel to protect the nerve, actually crushes the inflamed nerve, causing the symptoms we see with Ramsay Hunt syndrome, he explains.

Symptoms can include:

  • Pain in or behind the ear
  • Rash surrounding the ear or on the impacted side of the face (some have reported a rash inside the mouth as well)
  • Hearing loss or ringing in the ears
  • Dizziness or vertigo
  • Weakness on one side of the face that causes difficulty in closing the eye, eating, making expressions, talking, or moving
  • Paralysis (palsy) or facial droop

Dr Robert Quigley, an immunologist specialising in infectious disease, adds that on rare occasions the virus can spread to other parts of the brain or spinal cord, causing additional symptoms like confusion, headaches, and nerve pain.

How is Ramsay Hunt syndrome diagnosed?

The first thing most people do if they suspect they may have Ramsay Hunt syndrome is to go to the emergency room to ensure they’re not having a stroke, Dr Kochhar says. A doctor can usually diagnose Ramsay Hunt syndrome just by the visual appearance of symptoms. But they can also diagnose it through a blood test to look for the varicella zoster virus, electromyography, lumbar puncture, MRI, nerve conduction, or a skin test. 

How is Ramsay Hunt syndrome treated?

Healthcare providers will typically prescribe strong anti-inflammatory steroids or anti-viral medications to reduce inflammation that works quickly to fight the virus, Dr Kochhar says. These are typically acyclovir, famciclovir, or valacyclovir, adds Dr Quigley.

Dr Quigley adds, depending on the symptoms, other treatments may include anti-anxiety medication, anti-seizure medication, and pain relief medications.

The faster someone gets treated for Ramsay Hunt syndrome, usually within the first three days of symptoms, the better the outlook is, Dr Quigley says. Recovery from Ramsay Hunt syndrome depends on the severity of the nerve damage. Most people will recover completely in just a few weeks, but some may not recover fully, leaving facial paralysis and nerve damage permanent if the patient is unresponsive to medications or begins treatment too late.

Dr Kochhar says more than 90% of those with Bell’s palsy can recover in just a few weeks, but Ramsay Hunt syndrome has a much lower chance of recovery in that time frame. He suggests it’s more realistic for two to three months of recovery, and that looks different for everyone. Research suggests only 70% of those with Ramsay Hunt syndrome can get full facial function back.

He adds there isn’t much someone can do for rehabilitation other than waiting it out, taking the medication your doctor prescribes, and getting lots of rest.

We’re hoping for a full and speedy recovery for Bieber!

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