What is Ramsay Hunt syndrome and how has it affected Justin Bieber’s face?

Justin Bieber was struck down by Ramsay Hunt syndrome (RHS) this week - a rare neurological disorder that has forced him to postpone upcoming US shows from his 130-date Justice World Tour. Bieber posted a three-minute video on his official Instagram page on Friday, detailing how the disorder has left him unable to move the right side of his face.

“Hey everyone, Justin here, I wanted to update you guys on what’s been going on. Obviously as you can probably see with my face. I have this syndrome called ‘Ramsay Hunt syndrome’ and it is from this virus that attacks the nerves in my ear, my facial nerves and has caused my face to have paralysis,” he explained. “As you can see this eye is not blinking. I can’t smile on this side of my face ... So, there’s full paralysis on this side of my face”.

The Canadian singer said his condition is “pretty serious” but he is receiving treatment which gives him a chance of making a full recovery. If treated promptly, RHS will usually clear up within a few weeks but if left untreated, the condition can last months with the possibility of suffering permanent damage.

What is Ramsay Hunt syndrome and what causes it?

Ramsay Hunt syndrome is a neurological disorder which is characterized by paralysis of the facial nerve (facial palsy) accompanied by an erythematous vesicular rash affecting the ear or mouth. Other symptoms can include ringing in the ears (tinnitus), nausea, vomiting, vertigo and loss of taste or hearing.

RHS is caused by the varicella zoster virus (VZV) - the same virus that causes chickenpox in children and shingles (herpes zoster) in adults. After a bout of chickenpox clears up, the varicella zoster virus remains dormant in the patient’s nervous system and there is always a possibility that it might reactivate years later in adulthood. Usually the body’s immune system can fight it off but RHS can develop if the immune system is compromised or low.

The disorder is named after James Ramsay Hunt, an American neurologist who first described the disorder (type 1 and type 2) in New York in 1907. Bieber is suffering type 2 - the weakening of muscles affected by the facial nerve is known as Bell’s palsy which tends to be temporary and most sufferers recover and can return to normal life within weeks.

Can Ramsay Hunt Syndrome be treated?

Antibiotics or antiviral medications such as acyclovir or famciclovir, can be taken in conjunction with corticosteroids, like prednisone. Over-the-counter pain relievers and anti-inflammatory drugs such as ibuprofen (Advil, Nurofen, Motrin IB… etc.) can be taken to help reduce swelling and discomfort.

It is recommended that antiviral treatment should be administered within three days of the onset of symptoms. Despite therapy, some degree of facial paralysis and hearing loss may become permanent in some severe or untreated cases.

Bieber continues his recovery and so far, three of his concerts have been postponed - two dates at Toronto’s Scotiabank Arena and one at the Capital One Arena in Washington DC. He has four concerts scheduled for next week - two at Madison Square Garden in New York City, followed by stopovers in Philadelphia and Uncasville, Connecticut - it looks likely that those shows will also have to be rescheduled.