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Down But Not Out

Justin Bieber Tackles Ramsay Hunt Syndrome

Justin Bieber singing

Pop star Justin Bieber is well known for his catchy hits and his creative dancing, but recently he became the face of a rare neurological disorder called Ramsay Hunt syndrome, which causes partial facial paralysis.

Ramsay Hunt syndrome is caused by the varicella-zoster virus that causes chicken pox and shingles, according to Elizabeth Andekian, a nurse practitioner for OSF HealthCare. The virus can stay dormant for years in people who’ve had chickenpox as a child. It’s unknown why it reactivates.

“Ramsay Hunt is a form of facial paralysis that is caused by the herpes zoster infection and it affects the facial nerve, it causes inflammation or damage to the facial nerve and sometimes it affects the other cranial nerves as well," says Andekian. 

According to Andekian, Ramsay Hunt syndrome is rare; only five in 100,000 people in the U.S. are affected by the virus each year, typically older adults. Bieber is 28.

“He is kind of young to have this," says Andekian. "Typically we are going to see this in adults 60 and older, but that is not a hard and fast rule so, theoretically, anyone can get it because it’s a reactivation of the chickenpox virus.”

The symptoms of Ramsay Hunt syndrome vary. Some people experience paralysis of the facial nerve, a rash affecting the ear and the inability to close one eye. In most people, including Bieber, only one side of the face is affected. Other symptoms include hearing loss, ringing in the ear and vertigo.

Treatment includes steroids to reduce the inflammation, antiviral and pain medications. The key, according to Andekian, is starting treatment as soon as possible.

“The prognosis for Ramsay Hunt is pretty variable," says Andekian. "Typically, if treatment is started within three days, patients have a very good prognosis. The facial paralysis will resolve and with time the blisters will resolve on their own as will the scabs. However, if treatment is delayed patients can have permanent effects – permanent facial paralysis, hearing loss and dizziness and ringing in the ears or tetanus.”

Andekian also points out the importance of people 50 and older and people 19 and older who are immune compromised, getting the shingles vaccine. The vaccine can minimize both the effects of shingles as well as Ramsay Hunt syndrome.

Bieber was forced to postpone several concerts as he continues to rest and recover from his bout with Ramsay Hunt syndrome, but he promised fans he will be back at some point.  How long it will take for the pop star to fully recover, however, is anyone’s guess.

“I think the frustrating thing for people with Ramsay Hunt, and I’ve had a patient with Ramsay Hunt, it’s hard to know how long these symptoms are going to last," says Andekian. "We know, generally, patients who are treated within three days of symptoms appearing, tend to do better and have resolution of all of their symptoms, but there’s just no way to know for sure and I think the uncertainty is difficult for people.”

Interview Clips 

View Elizabeth Andekian, facial paralysis
Elizabeth Andekian, facial paralysis
Nurse Practitioner, OSF HealthCare
View Elizabeth Andekian, typical in older adults
Elizabeth Andekian, typical in older adults
Nurse Practitioner, OSF HealthCare
View Elizabeth Andekian, prognosis
Elizabeth Andekian, prognosis
Nurse Practitioner, OSF HealthCare
View Elizabeth Andekian, frustration
Elizabeth Andekian, frustration
Nurse Practitioner, OSF HealthCare