Speed is key to treating type of facial paralysis affecting Justin Bieber

June 15, 2022
Singer Justin Bieber posts on Instagram about his partial facial paralysis. He's demonstrating how one side of his face doesn't move properly.
Justin Bieber posted on Instagram about his bout with Ramsay Hunt syndrome, showing how it's affecting one side of his face.

Justin Bieber is not normally top of mind for Paul Lambert, M.D., whose musical tastes run more to Motown and R&B than pop music. But the distinguished university professor of Otolaryngology-Head and Neck Surgery at the Medical University of South Carolina did tune into the star’s recent health announcement.

“It caught my ear when they said that he had Ramsey Hunt syndrome because that is something that we occasionally see and treat,” Lambert said.

The Canadian singer announced on Instagram that he has the shingles-related condition, which has caused partial, and hopefully temporary, facial paralysis. Lambert explained the biological process that leads to Ramsay Hunt.

“It’s a reactivation of the chickenpox virus. The formal name of that is varicella zoster virus. So once a person gets chickenpox, this virus can remain dormant in the body for decades. Then it can suddenly break out. Even if you’ve had the chickenpox vaccine, you can still get this condition, though not as commonly and not as severely.”

There’s a vaccine to prevent the condition, Shingrix, but the Centers for Disease Control and Prevention recommends it for people 50 and older and people with weakened immune systems. Bieber is just 28.

Whatever the person’s age, Lambert said when the virus goes from dormant to active, it can infect a nerve. “That nerve can be anywhere on the body. Frequently it’s on the trunk or on the face, and we call it shingles. It presents as blisters or a rash with rather intense pain. Occasionally, it will infect the facial nerve.”

Dr. Paul Lambert 
Dr. Paul Lambert

That’s what happened to Bieber. “The facial nerve makes the side of the face move. When it infects that nerve, it usually causes a rash or blisters around the ear. Occasionally, that rash can extend onto the face or inside the mouth, but it’s usually on the ear proper. And it can cause a facial paralysis, as though someone has had a stroke on that side. So they can’t raise their eyebrow, blink their eye or smile on the involved side of the face.”

Ramsay Hunt can also cause hearing loss and/or dizziness in about a quarter of all cases, Lambert said. The good news is that the condition is treatable. “The important thing with this is to catch it early on, and early on means within the first three days, ideally. Usually we use an antiviral agent, the most common one we use is called famciclovir, and a steroid. If you treat within the first two to three days, then you can expect close to an 80% complete or very close to complete recovery.”

Lambert said Bieber’s willingness to talk about his illness may mean more people seek help quickly. Ramsay Hunt is characterized as rare by the National Organization for Rare Diseases, affecting an estimated five out of every 100,000 people. Lambert said it affects more than 100 South Carolinians a year.

“I think that it helps people understand that this can be a serious condition, and vanity aside, you need to see a specialist. That specialist could be your primary care physician or a neurologist or an ear, nose and throat physician. ENTs frequently treat facial paralysis.”

Lambert said that while most people recover from Ramsay Hunt, some end up with longer term facial dysfunction. “It is socially embarrassing. The more expressive they become, the more noticeable it is. So sometimes they’re a little shy to laugh and show more extreme emotions because it’s becomes apparent then.”

But they still have options that can ease those issues. There are a multitude of things that can be done to rehabilitate the either totally paralyzed face or partially paralyzed face. Those involve things from Botox to physical therapy to various types of surgery. The surgery is very sophisticated and only done at select centers such as MUSC. It can be very effective.”

Bieber, who has postponed performances while he recovers, said he’s feeling better every day and finds comfort in his faith in God. Lambert hopes his example will inspire others to also put their trust in fast treatment. “There’s a window of opportunity that you really need to take advantage of to maximize the outcome and the chance for a normal appearance.”

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