[1] It is traditionally defined as a triad of ipsilateral facial paralysis, otalgia, and vesicles close to the ear and auditory canal.

[citation needed] The varicella zoster virus infects people and results in a distributed vesicular rash with fever, known as chickenpox.

It may reactivate under conditions of physiological stress or if the immune system is suppressed in any way (for example during an illness or undergoing chemotherapy), resulting in herpes zoster, also known as shingles or Ramsay Hunt syndrome when facial paralysis in involved.

Ramsay Hunt syndrome type 2 can be diagnosed based on clinical features; however, in ambiguous cases, PCR or direct immunofluorescent assay of vesicular fluid can help with the diagnosis.

[citation needed] On a physical exam, look for vesicular exanthema on the external auditory canal, concha and or pinna.

If central nervous system complications such as meningitis, ventriculitis or meningoencephalitis are suspected, prompt lumbar puncture with spinal fluid analysis and imaging (CT head) are recommended.

[citation needed] An MRI with contrast may be ordered if the diagnosis is ambiguous so as to rule out other causes of acute facial paralysis such as a stroke, Lyme disease, multiple sclerosis, cancer or tumors.

[4][2] Studies indicate that treatment started within 72 hours of the onset of facial paralysis improves the chances of the patient experiencing significant recovery.

During the acute recovery phase, the eye on the affected side of the face may not blink completely or at all and may not close tightly or at all when sleeping.

[2] Nerve pain associated with Ramsay Hunt Syndrome may be extreme and centered in the ear, neck, cheek, jaw and face.

[2] Physical therapy, excessive movement or electrical stimulation practiced during the first year of recovery greatly increase the chances of long term complications, including hyperactive muscles and synkinesis, both of which are permanent.

The main factors affecting the overall prognosis are the severity of symptoms at onset, the age and general health of the patient and the timing of initial treatments Common long term effects include: Less common long term effects include: Some patients report an increased sensitivity to barometric pressure with changes in weather patterns causing pain on the affected side of the face.

[13] On June 10, 2022, Canadian singer Justin Bieber announced in a video posted on Instagram that he had been diagnosed with the condition.

[15] On May 18, 2023, The New York Times reported that United States Senator Dianne Feinstein had developed the condition as a side effect of a shingles infection.