The symptoms of Ramsay Hunt syndrome vary from case to case.

Affected individuals usually experience paralysis (paralysis) of the facial nerve and a rash that affects the ear.

These two symptoms do not always appear at the same time.

In most cases, only one side of the face is affected (unilateral). Facial muscles affected by nerve palsy may be weak or stiff and may result in the inability of affected individuals to smile, wrinkle the forehead, or close the eye to the affected side. In some cases, speech may become blurred.

Most cases of Ramsay Hunt syndrome have a reddish (erythematous), painful, blistering (vesicular) rash that affects the outside of the ear (pinna) and often the outer ear canal.

In some cases, the rash, including painful blisters, can also affect the mouth, soft palate, and upper throat.

Some individuals with Ramsay Hunt syndrome may have facial paralysis with evidence of varicella-zoster virus through testing (e.g., blood tests) but without skin-related abnormalities.

These cases can be referred to as shingles. Additional symptoms that affect the ear include tinnitus (tinnitus) and ear pain (otalgia). In some cases, the ear pain can be intense.

The pain can spread to the neck. Some affected individuals develop sensorineural hearing loss, a condition in which vibrations of sound are not properly transmitted to the brain due to a defect of the inner ear or auditory nerve, resulting in hearing loss. Hearing loss is usually temporary (transient), but in rare cases can become permanent.

In some cases, affected individuals may experience hyperacusis, a condition in which sounds appear louder (often dramatically) than normal.

This can cause great concern for the affected individuals. Additional symptoms that may be present include nausea, vomiting, and a sensation that one's surroundings are rotating (vertigo).

In rare cases, loss of taste, dry mouth, and dry eyes can also occur."