Canadian singer is experiencing facial paralysis and has taken time to rest and recover
Dubai: Even as friends and fans rally around Justin Bieber following his recent diagnosis with Ramsay Hunt syndrome, not much is known about the rare medical condition that affects five out of every 100,000 people annually in the United States, according to The National Organization for Rare Disorders (NORD).
The 28-year-old Canadian singer has been forced to cancel concerts from his Justice World Tour — although his UAE gigs remain unaffected as of now — with the condition paralysing one side of his face and hindering Bieber from even blinking effectively, as revealed in his Instagram post over the weekend. The ‘Peaches’ singer has said he’s been doing facial exercises and taking time to “rest and relax and get back to 100 per cent so I can do what I was born to do.”
While he hasn’t given an estimated timeline for his recovery, we breakdown the medical condition to understand how Ramsay Hunt syndrome affects people and what causes it.
In his own words, Bieber explained in the video to his legion of fans that his condition stems “from this virus that attacks the nerve in my ear and my facial nerves, and has caused my face to have paralysis.”
NORD describes Ramsay Hunt syndrome as a rare neurological disorder that can occur in people who were previously infected with chickenpox. If the dormant varicella-zoster virus (the same virus that causes chickenpox) is reactivated, leading to shingles, it can affect the facial nerve and may lead to facial paralysis and hearing loss.
Aside from facial palsy, other symptoms can include a rash affecting the ear or mouth. Ear abnormalities such as ringing in the ears (tinnitus) and hearing loss may also occur. In most cases, only one side of the face is affected. Additional symptoms that may be present include nausea, vomiting and vertigo, according to NORD.
Older adults are more likely to be affected. According to NORD, most cases affect those over 60. Ramsay Hunt syndrome affecting children is extremely rare.
According to the Mayo Clinic, to confirm the diagnosis, a doctor might take a sample of fluid from one of the rash blisters in the ear for testing. But in some cases, a rash may be completely absent and makes it difficult to diagnose.
Depending on the patient’s condition, Mayo Clinic says antiviral drugs, medications used to combat the chickenpox virus can be used, supplemented by medicines to help relieve vertigo and pain relievers, which can be severe in some cases.
While Ramsay Hunt syndrome isn’t contagious, according to the medical research, the reactivation of the varicella-zoster virus can cause chickenpox in people who haven’t previously had it. The infection can also be serious for people who have immune system problems.
In Bieber’s case, the condition has affected one side of his face. In the video posted on June 10, Bieber broke the news to his millions of fans, saying: “As you can see, this eye is not blinking, 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. So for those who are frustrated by my cancellations of the next shows, I’m just physically, obviously, not capable of doing them. This is pretty serious, as you can see.”
Dr Sharik Mustafa, Specialist Neurologist at Prime Medical Centre, Dubai added that in the case of Justin Bieber, one could expect a 95 per cent recovery with the immediate medical intervention, treatment and physiotherapy.
Dr Jose elaborated: “Ramsay Hunt syndrome is caused by a flare up of the varicella-zoster virus that causes chickenpox and shingles. Actually, when an individual contracts the varicella-zoster virus.
“These days, most young children are vaccinated with live attenuated virus and protected from chickenpox and shingles. In case of those who contracted it earlier and recovered, the virus never goes away, but continues to live in the ganglions of the nerves. These ganglions are relay centres of our nerves in any part of the body.
“In the case of Ramsay Hunt syndrome, the virus affects the ganglions of the seventh cranial nerve that results in facial paralysis. In this case, the flare-up must have started with manifestation of a rash below or behind his [Bieber’s] ear. This rash is usually vesicles or liquid filled boils which goes on to affect the facial muscles causing paralysis.”
Dr Mustafa highlighted the important difference between Ramsay Hunt syndrome and Bell’s Palsy, the more common type of facial paralysis from this condition.
“In the case of Bieber who had earlier been diagnosed with Lyme disease and indicates that his immunity has been compromised a bit and that is why he has been effected at such a young age.”
In physiotherapy, we focus on maintaining the muscle tone of the affected side and prevent any wasting of the muscle owing to its flaccidity. We usually alternate the treatment with galvanic stimulation, followed by ultrasonic treatment along the affected nerve track
Types of treatment
Prognosis for patients who get an early diagnosis and begin treatment is very good, said both the doctors. They added that quick treatment for Ramsay Hunt syndrome included a strong antiviral course that could last up to a year. In addition, electrical stimulation of the facial nerve and other physiotherapy can help maintain the muscle tone to prevent muscles getting flaccid. Dr Jose added that since Bieber was a vocalist, it was important to take care that his blowing capacity and sense of hearing was not affected and doctors could monitor this to prevent any deterioration. With antiviral, faradic face stimulation started the very same day the condition is diagnosed, one can expect a 95 per cent improvement within 3-6 weeks, added Dr Mustafa. Physiotherapy Protocol Patients with facial paralysis will experience weakness of muscles on the side impacted by the virus and will have difficulty in lifting the eyebrows, swallowing, chewing and have pain near the nerve track near the ear and neck pain as well. Deepa Chandran, Head of physiotherapy at Prime Healthcare explained the physiotherapy protocol for Ramsay Hunt syndrome or any other kind of facial paralysis. “In physiotherapy, we focus on maintaining the muscle tone of the affected side and prevent any wasting of the muscle owing to its flaccidity. We usually alternate the treatment with galvanic stimulation, followed by ultrasonic treatment along the affected nerve track,” said Chandra, adding: “We also provide a tailored programme for facial muscles that the individual can practice at home to keep the muscles supple. In addition, if the eye muscle is impacted we also provide strapping of the eyelid to prevent it from drooping. With a consistent exercise programmer the patient will see substantial benefits as the nerve generally takes 21 days or three weeks to regenerate.”
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