Ramsey Hunt syndrome
Background
- Reactivation of VZV in the geniculate ganglion of VII nerve
- Ear pain then rash in auditory canal / pinna or soft palate
- Assoc. facial N. (VII) palsy ± VIII involvement with vertigo, tinnitus and deafness
- Increasing incidence with age and immunocompromised
- Worse prognosis than Bell's (most VII in Bell's recover, only 50% in Ramsey Hunt)
Clinical
Symptoms
- Severe unilateral ear pain
- Facial (VII) droop
- Deafness, vertigo
Signs
- Unilateral LMNL VII
- Vesicular rash in ext. auditory canal ±mouth
- Vertigo / VIII signs (check gait and eye movements)
- Constitutional / septic upset
Differential Dx
- Bell's palsy:
- Bell's pain may be "mastoid" ache rather than severe pain deep within ear in Ramsey Hunt
- Hyperaceusis in Bell's (nerve to stapedius), deafness in Ramsey Hunt
- No VIII symptoms in Bell's, vertigo etc. more common in Ramsey Hunt
- Local ear infection (cellulitis, otitis externa, mastoiditis)
Management
- Early antivirals (intravenous)
- Early neurology / ENT involvement
- Consider steroids
Content by Dr Íomhar O' Sullivan 08/01/2020. Last review Dr ÍOS 10/06/21.