Ramsay Hunt Syndrome after covid vaccine: Can you get facial paralysis from the COVID-19 vaccine?

Ramsay Hunt syndrome is a painful rash around the ear, on the face, or on the mouth. It occurs when the varicella-zoster virus infects a nerve in the head.

Ramsay Hunt syndrome is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox in children and shingles (herpes zoster) in adults.

In cases of Ramsay Hunt syndrome, the previously inactive (dormant) varicella-zoster virus is reactivated and spreads to affect the facial nerve.

Ramsay Hunt Syndrome after covid vaccine

It recently diagnosed Ramsay Hunt syndrome (RHS) in a 37-year-old previously healthy man.

Two days after his first dose of the Pfizer-BioNTech (BNT162b2) vaccine, he noticed fever and pain in the right ear.

Vesicles were then developed in his right ear and canal, together with vertigo, tinnitus, and loss of hearing. He complained of facial palsy, tongue numbness, and dysgeusia.

On examination, he had grade 4 right facial nerve palsy of the lower motor neuron type with right sensorineural hearing loss.

As his symptoms developed 2 days after vaccination, it was suspected the vaccination triggered RHS. This would be the first reported case of RHS after the COVID-19 vaccination.

Can you get facial paralysis from the COVID-19 vaccine?

During the pivotal phase, 3 clinical trials of mRNA COVID-19 vaccines, several cases of facial paralysis were observed in the vaccine groups (7 of 35 654) compared with 1 case among people who received a placebo (1 of 35 611).1,2

Although a causal relationship could not be established from clinical trials, the US Food and Drug Administration recommended monitoring vaccine recipients for facial paralysis.

It was thus explored this potential safety signal through a disproportionality analysis using the World Health Organization pharmacovigilance database, VigiBase.