Ramsay Hunt Syndrome
Ramsay Hunt Syndrome is a recrudescent infection of herpes zoster (varicella zoster) which involves the sensory and/or motor component of the facial nerve (7th cranial nerve). The incidence is about 3-12% of all cases of facial paralysis in adult. In children, the incidence is about 5%. It is the second most common cause of acquired facial palsy.
The virus usually remains dormant in the geniculate ganglion. Once reactivated, the virus will replicates and been transmitted along the facial nerve and the surrounding skin.
The affected person commonly complains of severe otalgia (ear pain) before develops any facial asymmetry (due to the paralysis) or loss of sensation of the affected site. Otalgia is usually accompanied by vesicular eruptions around the ear and in the deep meatus. The eruptions will later rupture and become crusted. Some patients may also complain of hearing loss (which usually sensory neural). Some may present with vertigo as well.
If there is any suspicion of sensory neural hearing loss, an audiogram is indicated to look at the degree of the hearing loss. Facial nerve testing is not significant and will not change the management.
In terms of treatment, valacyclovir or famciclovir can be given up to 10 days. High dose of steroids help to decreases post herpertic neuralgia and may involve facial nerve function especially if the treatment is commenced early of the onset of the disease. Antibiotics and steroids eardrop may give some benefit in terms of prevention of bacterial superinfection in the ear canal. If there is any evidence of herpetic keratitis (eye involvement), ophthalmology referral should be done. In majority of patients, complete (or near complete) recovery is expected.
Reference:
- Michael J Ruckenstein. Comprehensive Review of Otolaryngology. Saunders. 2004.
- Judith Collier et al. Oxford Handbook of Clinical Specialties. 8th edition. 2009.
Tags: facial palsy, herpes zoster, Ramsay hunt syndrome
Technorati Tags: facial palsy, herpes zoster, Ramsay hunt syndrome
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