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

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

Justin Bieber performing on stage

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.

A young man undergoing acupuncture
Acupuncture has effectively treated symptoms of Ramsay Hunt syndrome even when conventional treatment has failed.

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.


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:

  1. Yang bai (GB14, 阳白)
  2. Quan liao (SI18, 颧髎)
  3. Jia che (ST06, 颊车)
  4. Di cang (ST04, 地仓)
  5. Yi feng (TE17, 翳风)
  6. He gu (LI04, 合谷)
  7. Tai chong (LR03, 太冲)
  8. Zu san li, (ST36, 足三里)
  9. Feng chi (GB20, 风池)
  10. Feng fu (DU16, 风府)
  11. 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.


  1. Complementary Therapies in Clinical Practice. 2020. A severe case of Ramsay Hunt Syndrome treated with acupuncture and related techniques. [Accessed 22 August 2022] 
  2. Journal of Neurology, Neurosurgery and Psychiatry. 2001. Ramsay Hunt Syndrome. [Accessed 22 August 2022] 
  3. Journal of Dental Anaesthesia and Pain Medicine. 2018. Ramsay Hunt Syndrome. [Accessed 22 August 2022] 
  4. The Journal of Craniofacial Surgery. 2015. Acupuncture: A potential modality for the treatment of auricular pruritus in Ramsay Hunt Syndrome with multiple cranial nerve lesions. [Accessed 22 August 2022] 
  5. Medicine (Baltimore). 2020. The efficacy and safety of acupuncture for Ramsay Hunt syndrome. [Accessed 20 September 2022]

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