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Watch: Justin Bieber forced to cancel shows after Ramsay Hunt Syndrome leaves star with facial paralysis
Justin Bieber has shared with his fans that he is suffering from a syndrome called Ramsay Hunt (RHS), which has caused him to have "full paralysis" on one side of his face.
The singer, 28, described it as "pretty serious", and explained he has had to cancel his upcoming tour shows to focus on resting, relaxing and "get back to 100% so I can do what I was born to do".
Posting a video speaking candidly to his 241 million Instagram followers, he showed the effects of the syndrome on his face, and said he'd been doing some facial exercises to help aid his recovery journey.
But as not many have heard of RHS, we take a look at what it is in more detail.
What is Ramsay Hunt syndrome?
RHS is caused by a virus in the facial nerve and is a more severe cause of facial paralysis, according to the NHS.
It "is a condition that is due to viral reactivation," explains Charles Nduka, a consultant plastic reconstructive surgeon who specialises in facial paralysis and founder of health charity Facial Palsy UK. "It's one of 60 causes of facial palsy, or facial paralysis as it is called in the States."
Facial Palsy UK's website says RHS specifically is a complication of shingles, and is the name given to describe the symptoms of a shingles infection affecting the facial nerve.
Shingles is the same virus that causes chickenpox (varicella zoster virus, or VZV). As a result of the infection, the facial nerve becomes inflamed and irritated. If you experience RHS, you will have previously had chickenpox, because once the spots heal and you recover, the virus continues to live in the nerves that it has infected. However, it remains harmless unless it is 'reactivated', at which point new symptoms will appear.
What are the causes?
"One of the things that is quite clear, certainly from talking to lots and lots of patients over the years, is that usually before it comes on, there’s some sort of intercurrent illness or stress, the immune system is a bit depressed,” says Nduka.
“Often people are experiencing other issues, socially or physically, and are rundown, and so, much in the same way as with shingles, you get this reactivation of the virus when the body’s immune system is no longer able to keep it under control.”
At times our immune system can become depressed and less able to fight off infection, reiterates Facial Palsy UK, meaning the body becomes vulnerable to 'reactivation' of the chickenpox virus, which stress is often a trigger for.
As studies have shown, stress can weaken the immune system and make people more likely to suffer from infections, stress is associated with outbreaks of shingles, which can then result in RHS.
Suggesting his lifestyle might have contributed to his diagnosis, Bieber said in his video that he feels "my body is telling me I gotta slow down".
You cannot catch RHS from an infected person, but people with no immunity to chickenpox can develop chickenpox from contact with the open rash or blister on a person with RHS.
What are the signs and symptoms?
Mr Nduka says RHS is often misdiagnosed as Bell’s Palsy – the most common cause of facial paralysis – and it also causes difficulties for diagnosis because of its varied presentation.
That said, the first sign of RHS is often a small rash, as well as weakness on the affected side of the face and loss of facial expression.
“It’s not always obvious, but you could have a really tiny patch of a rash inside your ear. It could be inside your mouth, or your tongue, in your throat, it could be anywhere or even not visible at all.”
Patients can also suffer from problems with their balance, earache and chronic pain, he adds.
Ramsay Hunt syndrome is NOT the same as Bell's palsy. It may look similar but it is different and is accompanied by other debilitating symptoms. See our mnemonic for more information. We hope @justinbieber feels much better soon.#RamsayHuntSyndrome #FOAMed pic.twitter.com/TI5H4SsAqB
— Facial Palsy UK (@facialpalsyuk) June 11, 2022
The complete symptoms of Ramsay Hunt syndrome, as listed by RHS, are:
A rash or blisters in or around the ear, scalp or hair line (blisters may also appear inside the mouth)
The rash/blisters are often painful with a generalised sensation of burning over the affected area
Weakness on the affected side of your face which causes the facial muscles to droop
Difficulty closing the eye or blinking on the affected side
Altered taste on the affected half of the tongue
Loss of facial expression on the affected side
Difficulty eating, drinking and speaking as a result of weakness in the lip and cheek on the affected side
Ear, face or head pain
Hearing loss on the affected side
Tinnitis (ringing in the ear) on the affected side
What is the treatment?
The NHS website says it treats RHS patients with steroids and antiviral medication and will give advice on eye care and facial rehabilitation.
It's also important that the type of facial paralysis is identified promptly, to ensure patients aren't incorrectly given treatment for Bell's Palsy, which is different.
“With Bell’s Palsy, patients need to receive oral steroids within 72 hours of onset to maximise the chance of recovery," explains Nduka. "Whereas, with Ramsay Hunt syndrome, they must receive steroids also, but in addition they must receive antiviral treatments, again as soon as possible after the onset, and if they don’t receive those then their rate of recovery drops from about 70% down to 50%.”
He also warns patients should not do unsupervised and excessive facial exercises, because "they can actually cause the recovery to become disorganised and end up with the face actually worse off than if they had just left things as they were to recover slowly”.
“It’s really important people just do what’s recommended and no more because it’ll do more harm than good,” he adds.
What does recovery look like?
Facial Palsy UK explains that if antiviral treatment is given within 72 hours of developing symptoms, 70% of people will, on the whole, experience a full recovery.
But if it is not given within this timeframe the likelihood of getting back to 'normal' reduces to 50%.
The more severe the damage, the longer recovery will take, and the lower the chance of regaining full function, whereas if the damage is mild, recovery should be achieved within a few weeks.
While the recovery process is similar to Bell's palsy, symptoms in RHS are often more severe.
If you experience any of these signs or symptoms, make sure you seek immediate medical help.
For support for people affected by facial paralysis, visit the Facial Palsy UK website.
Additional reporting PA.