Acupuncture has not been scientifically proven to be of benefit in cases of Ramsay Hunt syndrome except to relieve shingles pain or post herpetic neuralgia.
Botox* (botulinum toxin) has proven useful in the treatment of severe hypertonia (spasticity) of the facial muscles resulting from RHS. Hypertonia in RHS is one form of synkinesis, marked by an abnormal increase in the tightness of muscle tone and a reduced ability of a muscle to stretch (i.e. an increased stiffness). The connection between nerve and muscle may be blocked temporarily, without surgery, by injecting botulinum toxin into the muscle, resulting in relaxation of the muscle. It is difficult to determine the exact amount of the toxin to inject and where to inject it to optimize its effect without causing unnecessary paralysis. For this reason, it is important to have the procedure performed by a qualified board-certified physician who has extensive experience with using bolulinum toxin for this purpose. * Botox is produced by and a trademark of Allergan Pharmaceuticals.
Corticosteroids are often prescribed to reduce inflammation of the facial nerve. Their effectiveness is a matter of contention due to the difficulty of judging how well a patient would have recovered without treatment. This has lead to a situation where the decision to prescribe Coritcosteriods has been left to the personal opinions of the Doctor and the patient.
We strongly recommend against electrical stimulation of the facial nerves. Some doctors and physical therapists recommend using a TENS unit (electrical stimulator) to aid the healing process or prevent muscle atrophy. However, the latest thinking is that electical stimulation can encourage synkinesis and that the risks outweigh the possible benefits.
We strongly recommend that any facial exercises be deferred until the healing of the nerves is complete, a process that takes about two years. Some doctors and physical therapists recommend forcing the facial muscles to move to aid the healing process or prevent muscle atrophy. However, the latest thinking is that forced movement can encourage synkinesis and that the risks outweigh the possible benefits. Many patients experience a full recovery without ever performing facial exercises.
Nerve Decompression Surgery
Nerve decompression surgery has for a long time been used to treat nerve compression in conditions like Carpal Tunnel Syndrome. However the surgery is not recommended for RHS.
Facial paralysis resulting from RHS frequently affects clarity of the patient's speech, particularly sounds which require firmness of the lips to execute, for example, the sounds "B," "P," and "F." Speech therapy by a trained therapist may be recommended to optimise speech clarity, particularly if the paralysis lasts more than a few weeks.
Surgical Nerve Grafting
About 90% of idiopathic facial paralysis cases recover without the need for further treatment or therapy. However, long term cases may consider surgery to repair or replace the damaged nerve.