Singer Justin Bieber said he was diagnosed with Ramsay Hunt syndrome, which paralyzed half of his face. Key TakeawaysJustin Bieber said he was diagnosed with Ramsay Hunt syndrome, which has caused paralysis in half of his face.Ramsey Hunt syndrome is a rare condition that impairs the facial nerves.Getting treatment within 72 hours of symptom onset
Singer Justin Bieber announced that he was diagnosed with a rare condition called Ramsay Hunt syndrome (RHS), which has paralyzed the left side of his face.
The 28-year-old pop star canceled some upcoming shows of his world tour because of the illness.
“For those who are frustrated by my cancellations of the next shows, I’m just physically obviously not capable of doing them,” Bieber said to his fans in an Instagram video. “This is pretty serious, as you can see. I wish this wasn’t the case, but obviously my body is telling me I gotta slow down.”
“As you can see, this eye is not blinking. I can’t smile on this side of my face. This nostril will not move," he said.
RHS is a rare neuro-dermatologic condition that causes facial paralysis and a painful rash on a person’s ear or nose. In some cases, a person may experience facial paralysis without a rash, or vice versa.
“When a child has chickenpox, they will heal and recover, but the virus continues to live in the nerves that were infected, including the facial nerve,” Amit Kochhar, MD, director of the Facial Nerve Disorders Program at the Pacific Neuroscience Institute, explained in an email to Verywell.
He said that most patients will not develop RHS or shingles after recovering from chickenpox, but reactivation of the virus could inflame or irritate the facial nerve, leading to new symptoms.
Only about five in every 100,000 people contract RHS each year, and about 7% of the annual facial paralysis cases are attributed to RHS. Most people who develop the condition are older than 60.
The duration of RHS depends on the intensity of the condition and how quickly a patient receives treatment. Treatment usually involves an antiviral medication like acyclovir, which is sometimes combined with a steroid.
People who begin antiviral treatment for RHS within 72 hours have about a 70% chance of full recovery, compared to 50% for those who are not.
Derek Chong, MD, vice-chair of neurology at Lenox Hill Hospital, told Verywell that RHS recovery typically takes a few months, though this varies case by case.
"Basically, the virus gets into the [facial] nerve, and the nerve can actually be so injured that the whole nerve needs to regrow from the area of where it was injured," Chong said.
Impaired nerves are also the cause of facial paralysis, as Bieber showed in his video. As a patient heals, the nerves will have to grow and reconnect to their endpoints, Chong added.
While RHS affects a person's facial nerves, it does not affect the vocal cords directly. However, lingering symptoms might impair a patient's ability to control their lip movement.
For people with RHS, facial exercises like saying different letter sounds or practicing a smile can help strengthen still-working nerves, Chong said. For safety and to avoid overuse, these exercises should be performed under the guidance of a physical therapist, he added.
Several celebrities have suffered from other forms of facial paralysis, including the more common condition, Bell’s Palsy.
Angelina Jolie, George Clooney, Pierce Brosnan, and Katie Holmes are among a list of celebrities reported to have been diagnosed with and recovered from Bell's Palsy. These cases lasted for a few weeks to a few months.
Bell’s Palsy is relatively similar to RHS in symptoms, although it does not produce a rash. It is often treated with steroids like prednisone, which can speed up or optimize the chance of full recovery.
A doctor may also prescribe antiviral medications like Valtrex (valacyclovir) for Bell’s Palsy. The cause of Bell’s Palsy is often unknown, although it can be triggered by a viral infection.
RHS is sometimes considered related to Bell's Palsy, Chong said. In cases of RHS where a rash is not present, it can be hard for an accurate diagnosis, he added.
Bell’s Palsy affects about one in 5,000 people a year. Without treatment, the recovery rate is more than 70%, and rates increase when treatment is administered. When compared to those with Bell’s Palsy, patients with RHS are less likely to fully recover. But that doesn’t mean full recovery is impossible–and recovery rates increase with early treatment interventions.
RHS is not contagious on its own. However, exposing someone to the virus that causes RHS can give them chickenpox or shingles, if they are not vaccinated against chickenpox or have not had an infection before. Direct contact with open blisters or rash is the most common way of contracting chickenpox from a person with RHS.
Bieber announced he will be taking time to rest and recover in order to return to his music career.
The three most important things to do if you have been diagnosed with RHS are to start taking your antiviral medications as soon as possible, rest, and hydrate, Chong said.
"You want to optimize your conditions for your immune system to work to contain the virus," Chong said of Bieber's decision. "He's trying to rest and not overdo it and keep his energy so that it could be focused towards the both of both of the virus and recovery."
“This ain't it,” Bieber said to his fans. “I gotta go get my rest on so that I can get my face back to where it's supposed to be."
"Thanks for being patient with me," he added. "I’m gonna get better.”
Ramsay Hunt syndrome is a rare condition that can lead to facial paralysis and a painful rash. Getting treated within three days of symptom onset increases the chance of a full recovery.