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Justin Bieber has been forced to cancel several tour dates for health reasons, after a viral infection led to him developing the facial paralysis condition Ramsay Hunt syndrome. "As you can see, this eye is not blinking," Bieber said in an Instagram video. "I can’t smile on this side of my face. This nostril will not move, so there’s full paralysis on this side of my face."
In a new video on his channel, YouTuber and medical educator Dr. James O'Donovan provides a more detailed breakdown of this phenomenon, and explains that Ramsay Hunt manifests as a result of the varicella-zoster virus (VZV), the same virus which causes chickenpox.
"Ramsay Hunt syndrome occurs when you get an outbreak of the varicella-zoster virus that affects the facial nerve near one of your ears," he says. "The two main signs or symptoms of Ramsay Hunt syndrome are firstly a painful red rash with fluid filled blisters on, in, or possibly around one ear. Secondly, you can get facial weakness or drooping on the same side as the affected ear. Typically the rash and the facial paralysis occur at the same time, but sometimes one can happen before the other, and other times the rash never occurs."
Other less common symptoms include ear pain, hearing loss, tinnitus, vertigo, a change in your sense of taste brought on by the affected nerves, and difficulty in closing one eye. This final symptom can be quite serious, as if the eye can't close fully then the surface of the eye will quickly dry out, leading to inflammation of the cornea.
"Typically a thorough history and a good clinical examination are enough to diagnose Ramsay Hunt," says O'Donovan. Immediate treatment, he continues, will usually involve seven days of antiviral medication, high dose steroids, and pain relief.
"Timely intervention, especially with the steroids and antivirals, can influence prognosis," he adds. "Early recognition and commencement of the steroids and antiviral therapy within the first 72 hours is thought to maximize the chance of a good recovery."
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