Reviewed by Veena Angle, MBBS, MD and Tjai Kang Jie

Ramsay Hunt Syndrome: The Rare Disease Behind Justin Bieber’s Facial Paralysis

Published October 6, 2022| 7 min read

Ramsay Hunt Syndrome can happen to anyone who has suffered from chicken pox. Know the treatment options in Western and Traditional Chinese Medicine.

Have you heard of Ramsay Hunt Syndrome? It is the condition that paralysed half of singer Justin Bieber’s face several months ago. It’s also called herpes zoster oticus and is a complication of chickenpox.

After you’ve recovered from chickenpox, the virus lies dormant in your body. It may reactivate years later and attack the nerves, causing shingles. When the shingles attack involves the facial nerves, it can cause facial paralysis, known as Ramsay Hunt Syndrome. Thankfully, the condition is usually reversible, though the recovery can take a long time. Early diagnosis and treatment help improve the chances of a full recovery.

Ramsay Hunt Syndrome occurs only in people who have had chickenpox in the past and is more common in older adults aged 60 and above. The condition isn’t contagious but reactivation of the varicella-zoster virus can cause chickenpox in people who have not had it or have not been vaccinated for it. This happens if you come into contact with the fluid from blisters that form on an affected person.

Serious complications can arise in people with weak immune systems. If you suffer from Ramsay Hunt syndrome, stay away from newborns, pregnant women and people with vulnerable immune systems until your rash blisters scab over. As most children are now routinely vaccinated for chickenpox, the incidence of the disease will likely decrease.

Symptoms of Ramsay Hunt Syndrome

A man touching his face, checking if he has Ramsay Hunt Syndrome — Ramsay Hunt Syndrome causes facial paralysis and shingles in the ear.

The three cardinal features of Ramsay Hunt syndrome include paralysis of half of the face, pain in the ear and boils in the ear canal. Rashes and facial paralysis usually appear simultaneously. However, at times a rash may not appear at all.

Other symptoms to note include changes in sensation of taste, dry eyes, watering of the eyes, sensitivity to sounds, a blocked nose and difficulty in speaking. If other nerves are involved, you may also get associated symptoms. For example, if the vestibulocochlear nerve is affected, it may cause hearing loss, ringing in the ears and dizziness.

Though the symptoms of Ramsay Hunt Syndrome are usually temporary, some people may develop complications. These include permanent hearing loss and facial weakness, eye damage and pain.

Contact your doctor immediately if you experience facial paralysis or a shingles-like rash on your face. Beginning treatment within three days from the first sign of symptoms improves the chances of a full recovery and prevents long-term complications.

Treatment of Ramsay Hunt Syndrome

Being a viral illness, the treatment of Ramsay Hunt syndrome in Western medicine involves using antiviral drugs. Other medications are also given to reduce pain and other symptoms.

According to Traditional Chinese Medicine (TCM) Physician Tjai Kang Jie, the internal basis of the syndrome is a weak body constitution and insufficient essence in the brain. “Strong pathogenic qi (vital energy) can seize on the weakness of the body and invade the ear, face and brain, disrupting the flow of qi and blood, injuring the tendons and vessels, and weakening the muscles,” he says.

Physician Tjai explains that the TCM treatment of Ramsay Hunt syndrome involves a combination of acupuncture and herbal medication. The aim of this treatment is to dispel pathogenic qi and strengthen the body to improve the ear, face and brain systems.

Acupuncture

Research conducted by researchers from Kunming Medical University in China found that in TCM, the condition leads exogenous pathogenic factors to invade the Yang Ming (阳明), Shao Yang (少阳), and Tai Yang (太阳) channels. This results in the blocking of facial meridians, disorder of qi and blood activity, and loss of nourishment of facial muscles and tendons.

Acupuncture can recuperate qi activity, eliminate exogenous pathogenic factors, and activate blood circulation to clear collaterals.

An acupuncturist will focus on the following acupoints:

Located above the left eye, on the left side of the forehead.

Directly below the outer corner of the eye in a depression on the lower border of the cheekbone.

One finger width anterior and superior to the angle of the lower jawbone at the belly of the cheek muscle with teeth clenched.

Directly below the pupil lateral to the corner of the mouth.

Behind the earlobe, in the depression between the jaw and mastoid process.

An illustration of a left hand, showing he gu (LI4) acupressure point — He gu is located on the back of the hand, between the 1st and 2nd metacarpal bones. It helps dispel pathogens and restores and enhances qi and blood circulation within the meridians.

3D illustration of the Taichong (LV3) acupressure point — Located on top of the foot, in the depression closest to the first metatarsal space. It revitalises the Liver.

3D illustration of the zu san li acupoint — Located on the shin bone, four fingers-breadth below the depression of the knee joint, one finger-breadth (middle finger) from the anterior crest of the shin. It dispels pathogens to improve qi and fluid circulation within the meridians and revitalises the Spleen and stomach.

An illustration of feng chi as one of the acupressure points to heal symptoms of cold — Feng chi is located at the back of the neck, where you can feel a depression on the base of the hairline as shown above.

Located at the base of the brain, at the top of the neck and just below the bottom ridge of the skull cap.

On the midline of the lateral aspect of the thigh, 7 finger-breadths above the transverse popliteal crease.

Yang bai (GB14, 阳白)
Quan liao (SI18, 颧髎)
Jia che (ST06, 颊车)
Di cang (ST04, 地仓)
Yi feng (TE17, 翳风)
He gu (LI04, 合谷)
Tai chong (LR03, 太冲)
Zu san li, (ST36, 足三里)
Feng chi (GB20, 风池)
Feng fu (DU16, 风府)
Feng shi (GB31, 风市)

Here are some other ways and treatments you can consider if you suffer from the condition:

Home remedies

Keep the areas affected by rashes clean at all times. You may apply cool, wet compresses to the rash to reduce the pain. If your eyes become dry, use moisturising eye drops throughout the day. An eye ointment can help combat dryness at night.

Western medicine

Your doctor will prescribe antiviral medicines such as acyclovir, famciclovir or valacyclovir, which act against the chickenpox virus. A short course of steroids may also be prescribed to augment the effect of antiviral therapy. Painkillers may be given to tackle pain caused by the condition. Certain anti-anxiety medications like diazepam help to relieve vertigo.

Herbal remedies

Several cases of Ramsay Hunt Syndrome have been successfully treated using TCM remedies. However, they should be taken under the guidance of a licensed TCM practitioner, cautions Physician Tjai.

Herbs that can help with treating symptoms are mulberry leaf (sang ye, 桑叶), chrysanthemum flower (ju hua, 菊花), Cicada Slough (chan tui, 蝉蜕), peppermint (bo he, 薄荷), which expel Wind-Heat and clear the head and the eyes. Bombyx batryticatus (jiang can, 僵蚕) and earthworm (di long, 地龙) expel Wind and eliminate phlegm and Dampness. Buthus martensii Karsch (quan xie, 全蝎), and Ptyas dhumnades (wu shao she, 乌梢蛇) clear blockages in the meridians and expel Wind.

“TCM remedies are generally safe as long as they are administered by licensed TCM practitioners. Those experiencing sudden facial paralysis or hearing loss, immense vertigo or difficulty breathing or swallowing should seek immediate help from the nearest hospital instead,” he cautions.

Some herbal remedies that are used to treat chickenpox symptoms can be used on symptoms of Ramsay Hunt syndrome too. Just be sure to consult a TCM practitioner to determine if these herbs work for your symptoms and body constitution prior to using them.

To clear Heat from the body, TCM recommends Chinese herbs honeysuckle flower (jin yin hua, 金银花) and Weeping forsythia (lian qiao, 连翘). Herbs like Rehmannia root (sheng di huang, 生地黃) and figwort root (xuan shen, 玄參) can be used if your symptoms are more severe.

Certain cases of Ramsay Hunt Syndrome that don’t respond to conventional medical treatment have at times responded to TCM. However, as treatment is highly individualised, it is advisable to consult a TCM practitioner for the most appropriate therapy for you.

Justin Bieber has recovered from Ramsay Hunt Syndrome and resumed his world tour in Europe. However, as he has experienced, the condition can throw your life off balance and he has since decided to take time off, cancelling the Asian leg of his tour. So, if you notice any of the symptoms, don’t hesitate – quick treatment leads to a speedy recovery.