Bell’s palsy vs Ramsay Hunt syndrome  Checklist 

This is a handy checklist to understand the key symptoms that differ between Bell’s palsy and Ramsay Hunt syndrome (RHS).  You may only experience some of the possible symptoms listed.

Symptoms on the affected side	Bell’s Palsy	RHS
Paralysis
Paralysis or weakness of the facial muscles usually on one side of the face which can result in a facial droop.	Yes	Yes
Loss of facial expression due to muscle weakness	Yes	Yes
Difficulty eating and drinking due to weakness of the lip and cheeks.	Yes	Yes
Difficulty with speaking because of lip and cheek weakness especially sounds like ‘p’ and ‘b’.	Yes	Yes
Problems with eye closure and blinking which causes the eye to become dry.	Yes	Yes
Facial numbness	No	Yes
Hearing
Tinnitus or sounds coming from inside your ear and/or hypersensitivity to environmental sounds which makes everything sound too loud.	Yes	Yes
Hearing Loss	No	Yes
Pain
Facial Pain in or around the ear	Yes	Yes
Facial Pain as a result of muscle tightness	Yes	Yes
Severe and unremitting facial pain This can last for several weeks and months.	No	Yes
Blisters/rash
Rash, or fluid-filled blisters commonly found in or around the ear, in the hairline, inside your mouth (on the roof of your mouth or on your tongue), and in the throat.  Often painful.	No	Yes*
Sensations
Pins and needles over the face	No	Yes
Altered taste and/or dry mouth	Yes	Yes
Vertigo/dizziness	No	Yes

*Please note, not everyone with RHS will develop a rash or the rash may occur before or after the onset of facial weakness

FAQs

 

Why do you get hearing loss with Ramsay Hunt syndrome? 

This is because the shingles virus which causes RHS can affect other cranial nerves which run along a similar path to the facial nerve.  Bell’s palsy only affects the facial nerve.

Why is Ramsay Hunt syndrome pain more severe? 

Pain is difficult to classify but RHS tends to cause more severe pain symptoms because the shingles virus attacks the Trigeminal nerve.  The Trigeminal nerve is a nerve of sensation including pain.

Inner ear pain is often intense during the onset of symptoms.  Pain can involve the whole face and/or head and does not respond sufficiently to over the counter pain killers.

What causes facial numbness? 

Facial numbness is the result of damage to the Trigeminal nerve or fifth cranial nerve which can become infected with the shingles virus.

What causes the pins and needles sensation? 

This is due to the involvement of the Trigeminal nerve