LMN facial nerve palsy due specifically to varicella (herpes) zoster is Ramsay Hunt syndrome . Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on the anterior two thirds of the tongue. It can include deafness and vertigo and other cranial nerves can be affected. When the rash is absent it is known as zoster sine herpete; 2-23% of people with Bell's palsy actually have Ramsay Hunt syndrome. [ 12 ] It should be suspected when pain is significant, especially in those aged over 60. Immunodeficiency - for example, HIV - is a risk factor.