Ramsay Hunt Syndrome (RHS), also known as herpes zoster oticus, is a neurological condition that occurs when the varicella-zoster virus reactivates and affects the facial nerve. This comprehensive guide provides detailed information about the condition, its causes, symptoms, and treatment options.
Definition
Ramsay Hunt Syndrome is a complication of shingles that affects the facial nerve near the ear. It causes facial paralysis and a painful rash around the ear or in the mouth.
Also Known As:
- • Herpes Zoster Oticus
- • Ramsay Hunt Syndrome Type II
- • Geniculate Herpes
Key Facts
Primary Symptoms
Facial Paralysis
Weakness or complete paralysis on one side of the face
Ear Rash
Painful blisters in or around the ear
Severe Ear Pain
Often the first symptom to appear
Additional Symptoms
- • Hearing loss: Temporary or permanent
- • Tinnitus: Ringing in the ear
- • Vertigo: Dizziness and balance problems
- • Loss of taste: On the front two-thirds of tongue
- • Dry eye: Inability to close eyelid properly
- • Dry mouth: Reduced saliva production
- • Hyperacusis: Increased sensitivity to sound
Primary Cause
Varicella-Zoster Virus (VZV)
The same virus that causes chickenpox remains dormant in nerve cells and can reactivate years later as shingles, affecting the facial nerve.
How it develops:
- 1. Initial chickenpox infection (usually in childhood)
- 2. Virus becomes dormant in nerve ganglia
- 3. Virus reactivates due to various triggers
- 4. Affects facial nerve, causing RHS symptoms
Risk Factors
Clinical Diagnosis
Diagnosis is primarily based on clinical presentation, particularly the combination of:
- • Facial paralysis (usually unilateral)
- • Characteristic ear rash or blisters
- • Severe ear pain
- • History of chickenpox
Additional Tests
- • PCR testing: Confirms VZV presence
- • MRI: Rules out other causes
- • Audiometry: Assesses hearing loss
- • Electroneurography: Evaluates nerve function
- • Blood tests: Checks immune status
Critical Treatment Window
Treatment is most effective when started within 72 hours of symptom onset. Early treatment significantly improves the chances of recovery.
Antiviral Therapy
- • Acyclovir
- • Valacyclovir
- • Famciclovir
Reduces viral replication and nerve damage
Corticosteroids
- • Prednisolone
- • Methylprednisolone
Reduces inflammation and swelling
Supportive Care
- • Pain management
- • Eye protection
- • Physical therapy
Manages symptoms and prevents complications
Recovery Rates
Factors Affecting Recovery
- • Early treatment: Within 72 hours
- • Age: Younger patients recover better
- • Severity: Complete vs incomplete paralysis
- • Overall health: Immune system status
- • Compliance: Following treatment plan