Background: Ramsay Hunt syndrome (RHS) is an infective complication caused by the varicella zoster virus (VZV). It is characterised by both sensory and motor manifestations of the facial nerve. Other previously reported symptoms have included tinnitus, hearing loss, nausea, vertigo and nystagmus. In this instance, we describe a rare case of RHS resulting in cranial polyneuropathy with multiple cranial nerve involvement of VII, VIII, IX and X. Case Report: A 83-year-old male presented with a three-week history of occasional coughing with oral intake. He was noted on presentation to have vesicular lesions over the external auditory canal with a facial paresis. Superficial swabs from the lesions confirmed the presence of varicella zoster virus. He also developed vertigo from vestibular dysfunction, severe dysphagia with prolonged recovery and subsequent need for enteral nutrition for a period of 5 months. Conclusion: This case report highlights the need to be vigilant and screen for other cranial nerve involvement in patients presenting with RHS. This is particularly important given the potential to early treatment which may improve neurological recovery and subsequent outcomes such as dysphagia.