• Nalaka de Silva

Ramsay Hunt Syndrome

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.




DEFINITION


Herpes zoster oticus refers to a syndrome of acute otalgia accompanied by a herpetic, vesicular rash. When accompanied by facial paralysis, the syndrome is known as Ramsay Hunt syndrome.





Typical vesicles in the pinna











EPIDEMIOLOGY

Second most common cause of acute facial paralysis (second to bells)

Mostly over 60

M=F






PATHOPHYSIOLOGY

is induced by the reactivation of the varicella-zoster virus that remains latent in the geniculate ganglion after primary infection with chickenpox.






CLINICAL SYMPTOMS AND SIGNS

Prodrome

majority have viral prodrome with otalgia up to a week before FN paralysis


Vesicles

present with severe otalgia and vesicular eruption in the distribution of the nervus intermedius (see below)

90% pinna, 21% oral (palate, uvula, buccal mucosa, tonsil and tongue)

occurs before paralysis in 55% and after in 45%


VII palsy

Usually rapid onset (sometimes take longer than 3 weeks)

Dysgeusia-due to N intermedius involvement

Hyperacuisis-Stapedius?


Other Cranial Nerves

VIII

-20-40%) include SNHL and vestibular dysfunction

-Tinnitus/ vertigo

V Altered sensation



severe ocular complications

uveitis, keratoconjunctivitis, optic neuritis, and glaucoma and are almost always associated with involvement of the V1







How This Differ from Bells

Clinical-Intense otlagia/ vesicles/ involvement of other cranial nerves

Prognosis-Worse






TREATMENT

intravenous acyclovir (10 mg/kg three times daily)

oral acyclovir (800 mg five times daily)

oral valacyclovir (500 mg three times daily) for 10 days


In combination with a 3 week tapering course of prednisone (60 to 80 mg/kg daily)




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