Ramsay Hunt Syndrome is caused by the varicella-zoster virus, the same virus responsible for chickenpox and shingles. In RHS, the virus reactivates and affects the facial nerve near the ear. However, it doesn’t always stop there. The vestibulocochlear nerve, which controls both hearing and balance, is located very close to the facial nerve. When the virus spreads to this area, it can cause inflammation in the vestibular system, resulting in dizziness.

Not all dizziness related to RHS feels the same. Dizziness is an umbrella term that includes a wide variety of symptoms. Understanding the different kinds of dizziness can assist healthcare providers with knowing how to best treat your symptoms. Vertigo is a specific type of dizziness that feels like spinning, tilting, or a sense that the environment is moving when it’s not. This is most common in the early stages of RHS. This can be incredibly disorienting and may lead to nausea, balance problems, or difficulty standing and walking. Disequilibrium is often described as “rocking on a boat,” a feeling of the of imbalance or unsteadiness. This usually becomes chronic if not managed early. Some people describe their dizziness feeling like their head is in the clouds or not being connected to their own body, called Lightheadedness. In some cases, dizziness can also be accompanied by hearing loss, ear pain, or tinnitus (ringing in the ear). These symptoms can be frightening, especially when they occur without warning.

Managing chronic dizziness after the initial phase of Ramsay Hunt Syndrome requires patience and support, but recovery is possible. One of the most effective strategies is vestibular rehabilitation therapy (VRT), a specialized form of physical therapy that helps retrain the brain to adapt to changes in balance signals. Exercises in VRT can help reduce dizziness, improve stability, and restore confidence in walking or daily movement. In addition to therapy, staying well-hydrated, getting enough rest, and minimizing sudden head movements can help reduce dizziness episodes. It's also helpful to create a safe home environment—clearing clutter, using handrails, and adding nightlights can reduce the risk of falls.