What Ramsay Hunt Syndrome means for Justin Bieber and others with facial paralysis

Justin Bieber revealed in 2025 that he had developed facial paralysis due to Ramsay Hunt syndrome, a rare condition caused by the reactivation of the chickenpox virus affecting the facial nerve. 

The diagnosis came just before the surprise release of his album SWAG in July 2025.

Dr. Matthew Miller, director of the UNC Facial Nerve Center, explained that Ramsay Hunt syndrome occurs when the varicella-zoster virus, dormant since a previous case of chickenpox infection, reactivates in the geniculate ganglion, a cluster of nerve cells controlling facial movement and sensation. 

“Think of it as shingles of the facial nerve,” Dr. Miller said. “One in three people will get shingles, whereas Ramsay Hunt syndrome is much less common, affecting about one in 300 people.”

Symptoms of Ramsay Hunt Syndrome

The syndrome can appear suddenly and may include:

• Painful rash around or inside the ear, sometimes extending to the mouth or tongue
• Facial paralysis on one side, causing drooping or difficulty closing the eye
• Severe ear pain
• Hearing loss or tinnitus (ringing in the ear)
• Vertigo and balance problems
• Loss of taste or dry mouth and eyes

Complications

Without prompt treatment, Ramsay Hunt syndrome can cause permanent facial weakness, persistent pain (postherpetic neuralgia), or long-term hearing loss. Early medical intervention significantly improves recovery outcomes.

Treatment

Treatment focuses on reducing symptoms and preventing complications, including:

• Corticosteroids to reduce nerve inflammation
• Pain management through analgesics
• Eye care to prevent dryness if the eyelid cannot close properly
• Physical therapy to restore facial movement

Medical experts stress that treatment is most effective if started within 72 hours of symptom onset.

For Bieber, timely recognition and care allowed him to continue performing and releasing music while recovering. 

Ramsay Hunt syndrome remains rare but treatable, and early detection is key to avoiding long-term effects.