 One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus.The major differences in this condition are the presence of small blisters, or "vesicles", on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).Reactivation of existing herpes zoster infection leading to facial paralysis in a Bell's palsy type pattern is known as Ramsay Hunt syndrome type 2.