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Ramsay Hunt Syndrome (Herpes Zoster Oticus)
Ramsay Hunt syndrome is a neurological disorder caused by the reactivation of Varicella-Zoster Virus (VZV) involving the geniculate ganglion of the facial nerve (cranial nerve VII).
� Cause (Etiology)
Reactivation of dormant chickenpox virus
More commonly seen in:
Elderly individuals
Immunocompromised patients
People under severe stress
� Cranial Nerves Involved
Facial nerve (CN VII) – primarily affected
May also involve:
CN VIII (Vestibulocochlear nerve) → hearing and balance problems
Occasionally CN V, IX, and X
� Classic Clinical Triad (Key Feature �)
Ipsilateral lower motor neuron facial palsy
Severe ear pain (otalgia)
Vesicular eruptions involving:
External auditory canal
Pinna
Tympanic membrane
Sometimes oral mucosa (soft palate or tongue)
� Associated Symptoms
Reduced hearing
Ringing sensation in the ear (tinnitus)
Vertigo or imbalance
Sensitivity to loud sounds (hyperacusis)
Loss of taste from the anterior two-thirds of the tongue
Dry eyes or dry mouth
� Diagnosis
Primarily clinical diagnosis
Laboratory tests (PCR or serology) if confirmation is required
Audiological evaluation if hearing loss is present
� Treatment Approach
� Medical Management
Antiviral therapy: Acyclovir or Valacyclovir (most effective if started within 72 hours)
Systemic corticosteroids: Prednisolone
Adequate pain control
Eye care: artificial tears, eye protection, patching if needed
� Physiotherapy & Rehabilitation (Very Important)
Facial muscle strengthening exercises
Selective electrical stimulation (when indicated)
Education regarding eye protection
Vestibular rehabilitation for balance issues
� Prognosis
Recovery is generally poorer compared to Bell’s palsy
Early diagnosis and prompt treatment improve outcomes
Delay in therapy may lead to persistent facial weakness
Video credit: Dr Manish Prakash, ENT
20/07/2024
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