Internationally acclaimed singer, Justin Bieber announced over the weekend that some of his concerts have been cancelled. Bieber confirmed he has Ramsey-Hunt Syndrome, which causes facial paralysis. Is it common? What about recovery? A Rambam medical expert explains.
Popular Canadian singer, Justin Bieber announced that he has Ramsey-Hunt Syndrome. Ramsey-Hunt syndrome is rare and occurs when the varicella-zoster virus attacks nerves near the inner ear causing facial paralysis. Varicella-zoster is the same virus that causes chickenpox and shingles.
Dr. Yotam Shkedy, Attending Physician, Department of Otolaryngology-Head & Neck Surgery at Rambam Health Care Campus, explained; “There is a nerve that controls all the muscles on one side of the face, and if paralysis of the nerve occurs, it affects the facial muscles. A person cannot smile, their lips become lopsided and facial expressions are affected.
“One of the causes of Ramsey-Hunt Syndrome is a virus that attacks the facial nerve. The patient experiences ear pain. Symptoms also include fluid-filled blisters around the ear and oral cavity. It’s also common for people to suffer some hearing loss and it can also affect their balance.”
It sounds scary, but Dr. Shkedy emphasized: “Ramsey-Hunt is not life-threatening. It’s different to a stroke and the differences are clear. It affects a person’s quality of life - it’s hard to be seen out in public. Eating can be difficult and the patient can also experience dry eyes but, it’s not a life-threatening condition.”
What’s the cause?
Ramsay-Hunt syndrome is caused by the same virus that causes chickenpox - Herpes Zoster. The virus can continue to live in one’s nerve cells. After being dormant for many years it can sometimes, reactivate. Painful blisters may appear on the chest and if the virus attacks the facial nerve, the situation becomes more complicated.
Dr. Shkedy continued to explain: “As children, most of us have chickenpox but the virus can remain dormant in human nerve cells. Usually the virus remains dormant all of one’s life, but in some cases, after many years, it reactivates. We do not know why; it could be stress- or fatigue-related, or possibly something else.”
“The condition usually clears within a few weeks but full recovery usually takes 6–12 months.” Dr. Shkedy continued “When the reason for facial paralysis is unknown, we generally refer to it as Bell’s Palsy. Some 85-90 percent of Ball’s Palsy patients enjoy full recovery while only 70 percent of Ramsey-Hunt patients, experience full recovery. Some are left with permanent facial muscle weakness and lopsided facial features.”
How is Ramsey-Hunt treated?
“During treatment, the patient is mostly medicated with steroids and antivirals. These should be administered as soon as possible. Further down the line, if facial paralysis continues, physiotherapy is recommended. In the long-term, and in rare cases, if physiotherapy is ineffective, the patient can be treated with the Botulinum toxin (Botox) which is done here in the Department of Otolaryngology – Head & Neck Surgery at Rambam Health Care Campus, Haifa.”
Will Justin Bieber still visit Israel?
Will Bieber still perform in Israel – that’s the million-dollar question. Bieber is scheduled to perform in Israel in October. Dr. Shkedy pointed out that full recovery from Ramsey-Hunt usually occurs after 6–12 months, so we just don’t know.