Marta Korytkowska, SLP, On Justin Bieber's Ramsay Hunt Diagnosis And Symptoms - Exclusive Interview

For many of us, the first time we heard about Ramsay Hunt Syndrome was when Justin Bieber announced he was suffering from it in a shocking Instagram video. As the pop star shared, a virus attacked nerves in his face, causing paralysis. "This is pretty serious," Bieber intoned in the video, adding he's doing facial exercises to get better. While we join fans in expressing concern and well wishes for the singer, we also wanted to know more about Ramsay Hunt Syndrome and facial paralysis, so we turned to Marta Korytkowska, M.S., SLP-CCC, a speech language pathologist at Sacred Heart University in Connecticut. While she is not a primary care physician who would diagnose Ramsay Hunt, Korytkowska does diagnose and treat symptoms associated with the syndrome, including facial paralysis.

Before we delve into what Bieber might experience as a result of his diagnosis, let's look at how the illness comes about in the first place. According to WebMD, the virus that causes both chickenpox and shingles is responsible for Ramsay Hunt flaring up and agitating nerves in the face, potentially bringing on paralysis. Although the syndrome is rare — especially in people under age 60 — it's worth noting that anyone who's had chickenpox is technically at risk.

In our exclusive interview with Korytkowska, we find out more about what symptoms to look for and what treatments are available, as well as the prognosis for people whose facial function is impacted by Ramsay Hunt Syndrome.

First, can you tell us a bit about your background and area of expertise?

​I have nearly 10 years of experience as a speech language pathologist (SLP) in the medical setting. In my time as an SLP, I have worked in various settings including outpatient rehabilitation, inpatient rehab, private practice and acute care. In these settings I treat individuals who have difficulty with speech, voice, language and swallowing disorders as a result of neurological conditions such as Parkinson's, stroke, brain damage and others. Many of these conditions have an impact on cranial nerves.

In my research role, I work with individuals with neurological disorders and diagnoses. My main research areas are Parkinson's disease and Aphasia.

Clinically, speech language pathologists diagnose and treat the symptoms that arise from the medical diagnoses. For example, in the medical diagnosis of Ramsay Hunt Syndrome, the possible secondary diagnosis of symptoms would be dysarthria and/or dysphagia and impact on speech and swallow.

What are the short-term symptoms and possible long-term effects?

The virus impacts several cranial nerves either unilaterally (on one side) or bilaterally (on both sides). Cranial nerves impacted include the trigeminal nerve responsible for sensation to our face. Think about when you get novocaine at the dentist and you feel numb — this is because a portion of the trigeminal nerve is targeted. The trigeminal nerve also allows us to chew and move the muscles of our jaw.

The vestibulocochlear nerve responsible for hearing and balance [is also affected]. Damage here can impact hearing but also cause the individual to feel dizzy.

The facial nerve, which is responsible for movement of the face, including our lips, can lead individuals to have imprecise speech or inability to drink without spilling or keeping food in their cheek, known as pocketing.

Can you walk us through the symptom of facial paralysis that might result from Ramsay Hunt? How might this symptom manifest? What does it affect?

Facial paralysis can have implications in two main areas: speech and swallowing.

In the former, facial paralysis results in the inability to move certain articulators — structures we need for speech production — namely, the lips. Speech is a complicated act that requires complex, precise and timely movements of the articulators needed for clear and easily-understood speech. One can imagine that this is even more crucial in singing. Impairments can lead to distortions in speech and difficulty with understanding the individual known as dysarthria.

In the latter, we may see difficulty with saliva control and drooling on the affected side. We might also see difficulty forming a seal around a cup or straw, and spillage of liquids from the mouth. In addition, the storage of food in the cheek, known as pocketing, can be impacted.

What does a treatment plan for Ramsay Hunt look like, especially to address the symptom of facial paralysis?

​There are medical treatments such as antivirals. However, individuals should also seek assistance from a speech language pathologist. A speech language pathologist would evaluate dysarthria and dysphagia, and offer short-term solutions for compensatory strategies for both speech and swallow. For longer-term solutions and symptoms that persist, treatment is recommended as a personalized home exercise program — exercises with the help of a mirror or bio-feedback such as EMG. Individuals experiencing vertigo would also seek help from an audiologist who would work on assessment and treatment of vertigo and balance.

What do you know about Justin Bieber's case specifically? How might his career be impacted by Ramsay Hunt?

​Justin Bieber has reported that he has RHS. In his video announcing this diagnosis to his fans, Bieber shows the lack of eyelid movement, nostril flare and complete paralysis of his face. If you listen carefully, his speech is distorted and slightly imprecise. You can see a lack of a nasolabial fold. Moreover, you can see the contrast between the right and left side of his face, where there is significant asymmetry. You can see that only one side of his face is moving when he speaks and is almost pulling the other side. It is most noticeable in the smile. He notes that he is doing facial exercises, which is a common recommendation.

In terms of career and impact, the time that it will take someone to recover is unknown. Bieber relies on his articulators for his career. When and if recovery for articulator movement is reached, he is likely going to be able to continue. It is unclear if recovery will be complete.

When should you seek medical attention if you believe you may have symptoms of Ramsay Hunt?

Whenever a neurological condition is concerned, one must seek medical attention immediately. Symptoms seen in Ramsay Hunt, like vertigo and facial weakness, can also be present in a stroke, and this needs to be ruled out by a medical doctor, and as such, immediate attention and a trip to the nearest ER is essential.

Are there other similar syndromes or causes of facial paralysis we should know about?

​Facial paralysis is the result of damage to the facial nerve, which is responsible for facial movement. The trigeminal nerve is responsible for sensation to the face. Any damage to these nerves can cause facial paralysis or a lack of sensation to the face. Another diagnosis that leads to these difficulties is Bell's Palsy, as can any infarct to the brain stem.

View Marta Korytkowska's bio page on the Sacred Heart University website to learn more about her expertise in the field.