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Outcomes Research

Researchers Investigate Mechanics of Shingles-Associated Condition

Shingles, created by the same virus as chickenpox, often results in painful, blistering rashes in various areas of the body, including the neck and torso. In some cases, the rash can appear near the ear, impacting facial nerves that help with hearing and balance. This condition, known as vestibular neuritis (VN), is one of the more common causes of sudden onset vertigo and dizziness. The vertigo may be dramatic at the onset, but symptoms usually improve after a few weeks. However, in more severe cases, the shingles virus can also impact the nerve that controls facial muscles, leading to facial paralysis. Known as Ramsay-Hunt Syndrome (RHS), this condition is rare but produces devastating side effects, such as chronic dizziness, that impact quality of life.
“In most cases, the brain corrects vestibular function loss and your ability to perform daily activities improves over time,” explained Jeffrey T. Vrabec, MD, Professor of Otolaryngology. “RHS patients tend to have a much longer course of symptoms. The brain doesn't seem to adjust for the vestibular function loss in these patients the way it would in VN patients.” Much is known about the prognosis and recovery of VN, but gaps in the scientific literature on RHS highlight a need for further investigation.
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Jeffrey T. Vrabec, MD
Thus, Vrabec and colleagues designed a retrospective study to investigate the true impact of vestibular impairment in RHS patients. The study involved evaluating the rate and severity of vestibular loss and brain compensation in RHS patients and comparing this data to VN patient outcomes. “Because more is known about the prognosis and recovery of VN, comparing patient outcomes of the two conditions can help shed light on the severity of symptoms and potential prognosis of RHS patients,” Dr. Vrabec said. The study, published in Otolaryngology—Head and Neck Surgery, evaluated VN and RHS patients who underwent videonystagmography treatment between January 2019 and November 2023.
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Our main suspicion is that this virus continues to progress into the nervous system, propagating up the nerve pathway into the brain stem. We believe this is why RHS patients are not improving because the damage to the nervous system is more extensive.
Jeffrey T. Vrabec, MD
A total of 32 patients were identified, with 10 presenting with RHS and 22 with VN. Nearly all RHS patients exhibited significant ear pain, hearing loss, facial palsy and a shingles rash. Eight RHS patients received steroids and antiviral medication at the onset, while initial therapy was uncertain for the other two. After a mean follow-up of 2.7 years, symptoms showed variable improvement. Most patients stated ear pain had improved, with four reporting persistent pain at last follow-up. Facial palsy recovered in four patients, while others had persisting weakness. Three patients had mild improvement in hearing. Two patients remained with non-serviceable hearing despite treatment. While patients with VN may recover vestibular function in 40-63% of cases, all RHS patients in this study continued to show persistent and severe symptoms years after diagnosis. “Our main suspicion is that this virus continues to progress into the nervous system, propagating up the nerve pathway into the brain stem,” Vrabec explained. “We believe this is why RHS patients are not improving because the damage to the nervous system is more extensive.” While more research is necessary to understand the mechanics of RHS, Dr. Vrabec and colleagues speculate that longer courses of antiviral treatment at the onset of symptoms can help prevent further damage to the nervous system, thus improving long-term health outcomes in RHS patients. The researchers plan to explore this hypothesis in future projects. In the meantime, the study sheds light on the importance of the shingles vaccine, which can help lower the risk of shingles and RHS. No study participants were vaccinated for shingles even though most were over the age of 50, the recommended age range for the vaccine. Nationally, 26.1% of eligible adults are vaccinated for shingles, even though one in three people will develop shingles in their lifetime.
Callie Rainosek Wren, MS
February 2025