Justin Bieber recently announced that he would be canceling several shows due to having developed Ramsay Hunt Syndrome, a rare neurological disorder caused by the varicella-zoster virus (VZV). The virus itself is not rare, being responsible for chicken pox and the development of shingles, but what makes Ramsay Hunt Syndrome more unusual is where in the body the virus attacks.

Facial paralysis can be a symptom of Ramsay Hunt Syndrome as the virus affects the facial nerve causing palsy, a type of paralysis, which Bieber announced he was experiencing in a recent video posted to Instagram.

“Hey everyone, Justin here. I wanted to update you guys on what’s been going on,” he said. “Obviously, as you can probably see from my face, I have this syndrome called Ramsay Hunt Syndrome and it is from this virus that attacks the nerve in my ear, my facial nerves, and has caused my face to have paralysis."

“As you can see this eye is not blinking. I can’t smile on this side of my face. This nostril will not move, so it’s full paralysis on this side of my face.”

Chickenpox is a fact of life for many children across the globe, and once we have been infected with the VZV it remains in our system for the rest of our lives. For some people, VZV can later spontaneously reactivate and launch a secondary infection including shingles, which commonly affects the body's trunk but can affect the eye, too.

When the virus reactivates around the facial nerve, which sits at the bottom of the ear, the neurological disease is known as Ramsay Hunt syndrome. While it comes with several of the same symptoms as shingles, it can be harder to diagnose because the tell-tale vesicles are often hidden inside the ear canal.

Delayed diagnosis means delayed treatment, and infected people are expected to have the best chance of making a full recovery the sooner antiviral medications are given. Unfortunately, the rare nature of Ramsay Hunt Syndrome and its nondescript symptoms can mean that a diagnosis isn’t reached before facial paralysis sets in and for some people this damage can be permanent.

According to NORD, an organization that advocates for individuals with rare diseases, the key symptoms of Ramsay Hunt Syndrome include:

Severe ear painPainful, red, blistered rash around and inside the ear and ear canalRinging in the earAltered sense of hearingFacial paralysis, usually just on one sideVertigo

Unfortunately (as seems to be the case for just about any health news story of late), Bieber’s condition has attracted the attention of the anti-vax community who are claiming that his illness is related to the jab. While there are case reports of people developing Ramsay Hunt Syndrome shortly after vaccination, these accounts are described as “rare” and the result of stress-induced VZV activation rather than the shot itself causing the illness.

Young, otherwise healthy people don’t usually develop shingles or Ramsay Hunt Syndrome, but stress is a common trigger as it suppresses our immune function and increases our susceptibility to infection. It’s possible that a person who is wiped out after any vaccine could develop the neurological disease due to physiological stress, but the COVID-19 vaccine is no more to blame than any other stressor such as work or personal problems.

“This is pretty serious as you can see,” said Bieber. “I wish this wasn’t the case, but obviously my body’s telling me I gotta’ slow down and I hope you guys understand, and I’ll be using this time to rest and relax and get back to 100 percent so I can do what I was born to do.”

“I love you guys, thanks for being patient with me and I’m gonna’ get better and I’m doing all these facial exercises to get my face back to normal. It will go back to normal, it’s just time and we don’t know how much time that’s going to be but it’s gonna’ be okay.”