Justin Bieber Reveals that he has facial paralysis caused by Ramsay Hunt syndrome

Pop sensation Justin Bieber announced his face is partially paralyzed by a viral illness called Ramsay Hunt syndrome, caused due to the same varicella-zoster virus which causes diseases like chicken pox and even shingles.

He told viewers in a YouTube video that the infection had damaged the nerve in his ear and facial nerves and had caused his face to have paralysis. He also highlighted one of his eyes was not blinking, and he couldn't smile on one side of his face. Even his nostrils were not moving. For this, he canceled many of his pre-planned tours and events, which made his fans worldwide tremendously anxious.

What is Ramsay Hunt Syndrome?

Chickenpox in children and shingles in adults share the varicella-zoster virus, which is responsible for the neurological condition known as Ramsay Hunt syndrome. The virus can persist in your body for your whole life, even long after recovering from chickenpox and reawaken to irritate and inflame the nerves in your face. The nerves that travel through our face go through a narrow, bony canal; when swollen, they enlarge and lose the ability to function.

The condition affects men and women equally and can result in paralysis on one side of the face and severe, blistering rashes. It is more frequent in older adults. Some patients experience alterations in their hearing, maybe perceiving noises stronger in one ear than another or acquiring tinnitus, a chronic ringing in the ears, or even deafness in one ear. Ear and facial pain are usually a part of the illness, and some individuals may suffer from vertigo.

Properly intervention of Ramsay Hunt syndrome can lessen the risk of sequelae, including irreversible facial muscle paralysis and hearing.

Affected Population

One estimate states that every 5 in 100,000 people in the U.S. experience Ramsay Hunt syndrome each year. Equal numbers of boys and females are afflicted by the Ramsay Hunt syndrome. Anybody who has had chickenpox is at risk for developing Ramsay Hunt syndrome. The vast majority of patients, however, are above the age of 60. Ramsay Hunt syndrome is very rare in kids.

It might be challenging to estimate the actual prevalence of Ramsay Hunt syndrome in the general community because the disorder may go untreated or be incorrectly diagnosed.

Diagnosis of Ramsay Hunt Syndrome

While facial paralysis and rashes often occur together, there aren't many clinical entities that may cause both. Nevertheless, herpes simplex virus infections, impetigo due to Staphylococcus aureus, and contact dermatitis brought on by contact with irritants like poison ivy or topical treatments like neomycin are all common causes of localized face rashes. Bell's palsy, which manifests with symptoms like those of zoster sine herpete, is the most common cause of abrupt facial paralysis. Neurosyphilis, benign skull base tumors, Lyme disease, autoimmune illnesses, extratemporal malignancies, otologic diseases, and different viral infections are some more non-traumatic causes. Another example of a non-traumatic cause is a stroke.

Although brainstem strokes typically paralyze the full hemiface, cortical strokes spare the forehead. Nonetheless, a developing stroke should present with neurological symptoms in addition to facial paralyses, such as vital sign instability. Infections with viruses, such as SARS-CoV-2, and central nervous system pathologies can lead to multiple cranial neuropathies.

Risk Factors and Complications 

Any person who has had chickenpox is susceptible to Ramsay Hunt syndrome. Older folks are more likely to experience it; those over 60 are typically affected. Young children rarely develop Ramsay Hunt syndrome.

There is no spread of Ramsay Hunt syndrome. However, those who have never had chickenpox or the varicella-zoster vaccine are susceptible to the illness when the virus reactivates. For those with immune system issues, the infection may be severe.

Ramsay Hunt syndrome complications could consist of −

  • Permanent facial paralysis and loss of hearing − Ramsay Hunt syndrome-related hearing loss and facial paralysis are often transient for most persons. But it might stick around for good.

  • Eye harm − You could find it challenging to close your eyelid due to the facial weakness of Ramsay Hunt syndrome. When this occurs, the cornea, which guards your eye, may sustain damage. Eye pain and vision haze may result from this damage.

  • Post-herpetic neuralgia, an infection from shingles, destroys the nerve fibers, resulting in this painful illness − Ramsay Hunt syndrome causes these nerve fibers to send mixed-up and distorted messages, resulting in pain that might linger long after other Ramsay Hunt syndrome symptoms have subsided.


Antiviral drugs like acyclovir or famciclovir and corticosteroids like prednisone treat Ramsay Hunt syndrome. Together, the medications increase the effectiveness of treatment for the varicella-zoster virus. In particular, steroids or anti-inflammatory medicines may assist in lessening pain by lowering nerve inflammation. Antiviral drug effectiveness and advantages have not been established. Despite treatment, some patients may experience persistent hearing loss and facial paralysis.

Further treatment is focused on particular symptoms that each person may clearly see. This includes painkillers, carbamazepine, an anti-seizure drug that may help lessen neuralgic pain, and vertigo-suppressing drugs, such as antihistamines and anticholinergics. Diazepam (Valium), an anti-anxiety medication, can alleviate pain and vertigo.

The U.S. Food and Drug Administration (FDA) has approved capsaicin to treat post-herpetic neuralgia-related neuropathic pain. For maximum benefit, medication should be started within three days of the onset of symptoms.

Ramsay Hunt syndrome patients must take extra precautions to avoid corneal damage since they have trouble closing one eye. This can expose the cornea to abnormal dryness and foreign body irritation. The cornea can be protected by using lubricating ointments and artificial tears. It could be advised to wear an eye patch for some patients.

Both the chickenpox vaccine for children and the shingles vaccine for those over 50 can protect against the varicella-zoster virus. These immunizations can significantly lower the risk of catching the varicella-zoster virus, which reduces the risk of developing Ramsay Hunt syndrome.


Vaccine against chickenpox is regularly given to kids, significantly lowering the risk of contracting the virus. The shingles vaccine is also advised for those 50 years of age or older.