Ramsay Hunt Syndrome - Complete Guide

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.

What is Ramsay Hunt Syndrome?

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

Caused by varicella-zoster virus
Affects 5-10 per 100,000 people annually
Early treatment improves outcomes
Signs and Symptoms

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
Causes and Risk Factors

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. 1. Initial chickenpox infection (usually in childhood)
  2. 2. Virus becomes dormant in nerve ganglia
  3. 3. Virus reactivates due to various triggers
  4. 4. Affects facial nerve, causing RHS symptoms

Risk Factors

High Risk
Age over 60 years
High Risk
Immunocompromised state
Moderate Risk
Diabetes mellitus
Moderate Risk
Chronic stress
Elevated Risk
Autoimmune disorders
Diagnosis

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
Treatment Overview

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

Prognosis and Recovery

Recovery Rates

Complete Recovery
30-40%
Partial Recovery
40-50%
Minimal Recovery
10-20%

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