Justin Bieber reassures fans on Ramsay Hunt syndrome: What are the signs and symptoms?

Justin Bieber has reassured fans about his recovery after being diagnosed with a condition called Ramsay Hunt syndrome (RHS).

This follows the singer, 29, cancelling all of the remaining dates of his Justice world tour earlier this month. While the exact reason was not specified, it follows previous cancellations due to his diagnosis.

On Wednesday 15 March, Bieber posted a video to his Instagram stories, which shows him moving both sides of his face and smiling, hinting to his 281 million followers that he's doing okay after the facial paralysis he experienced last year.

In September, the star revealed he was taking a further break from his tour, after originally suspending it in June due to being diagnosed with the neurological disorder, which left part of his face paralysed.

Sharing the update to Instagram at the time, the star said his recent shows in Europe had “taken a real toll on me” and he needs more time to “rest and get better”.

Bieber said he had given “everything I have” during a recent show in Brazil: “After getting offstage the exhaustion overtook me and I realised I need to make my health the priority right now.

“So I’m going to take a break from touring right now. I’m going to be OK but I need to take time to rest and get better.

“Thank you for all your prayers and support throughout all this. I love you all passionately.”

It came just over a month after Bieber announced his return to touring, having previously postponed several US dates.

At the time of his diagnosis, he posted a video showing the alarming physical effects of his condition, and told fans he had been doing facial expressions to regain movement but it would take time to recover.

So what exactly is RHS and what are the signs and symptoms to be aware of?

Read more: As Roman Kemp shares diagnosis and 'extreme tiredness' – what is sleep apnoea?

What is Ramsay Hunt syndrome (RHS)?

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 of RHS?

At times, our immune system can become depressed and less able to fight off infection, Facial Palsy UK explains, 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.

"One of the things that is clear, certainly from talking to 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 run-down, 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.”

Suggesting his lifestyle might have contributed to his diagnosis, Bieber said in his video in June that he felt "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.

Read more: Billie Eilish discusses Tourette’s syndrome – signs and symptoms of condition

What are the signs and symptoms of RHS?

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.

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

• Dizziness/vertigo

• Tinnitus (ringing in the ear) on the affected side

What is the treatment for RHS?

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%.”

Nduka 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.

Read more: What types of dementia are there? Signs and symptoms to see your GP about

What does recovery from RHS 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 the 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.

Watch: Justin Bieber surprises fans at Rolling Loud festival after cancelling tour