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.