Symptoms & Diagnosis

Early recognition of Ramsay Hunt Syndrome symptoms is crucial for timely treatment and optimal outcomes. This comprehensive guide covers all aspects of symptom recognition and diagnostic procedures.

Seek Immediate Medical Attention If:

• Sudden onset of facial paralysis with ear pain
• Appearance of blisters or rash around the ear
• Severe ear pain with hearing loss
• Inability to close eye completely
• Dizziness or balance problems with facial weakness

Remember: Treatment is most effective within 72 hours of symptom onset.

Typical Symptom Timeline

Days 1-2

• Severe ear pain
• Headache
• General malaise

Days 2-3

• Ear rash/blisters appear
• Facial weakness begins
• Hearing changes

Days 3-7

• Complete facial paralysis
• Vertigo/dizziness
• Taste loss

Week 2+

• Symptoms stabilize
• Recovery may begin
• Complications possible

Neurological Symptoms

Facial Paralysis

Primary

Unilateral weakness or complete paralysis of facial muscles

Loss of Taste

Common

Reduced taste sensation on anterior two-thirds of tongue

Hyperacusis

Common

Increased sensitivity to sound in affected ear

Facial Numbness

Variable

Reduced sensation in facial nerve distribution

Auditory & Vestibular

Severe Ear Pain

Primary

Often the first symptom, deep aching pain

Hearing Loss

Common

Sensorineural hearing loss, may be permanent

Tinnitus

Common

Ringing, buzzing, or roaring sounds in ear

Vertigo

Common

Spinning sensation, balance problems

Ocular Symptoms

Inability to Close Eye

Primary

Lagophthalmos due to facial nerve paralysis

Dry Eye

Secondary

Reduced tear production and blinking

Eye Pain

Secondary

Due to corneal exposure and dryness

Blurred Vision

Secondary

From inadequate eye lubrication

Diagnostic Criteria

Essential Criteria (Must Have)

1. Acute Facial Paralysis

Unilateral lower motor neuron facial nerve palsy

2. Vesicular Rash

In ear canal, auricle, or oral cavity

3. VZV Evidence

PCR positive or clinical presentation

Supporting Features

Severe otalgia (ear pain)

Sensorineural hearing loss

Vestibular dysfunction

Loss of taste (anterior tongue)

Hyperacusis

Reduced lacrimation

Diagnostic Tests and Procedures

Clinical Assessment

House-Brackmann Scale

Initial and follow-up

Assess degree of facial paralysis

Neurological Examination

Initial assessment

Evaluate cranial nerve function

Otoscopic Examination

Initial assessment

Visualize ear canal and tympanic membrane

Laboratory Tests

VZV PCR

Within 72 hours

Confirm varicella-zoster virus presence

VZV IgM/IgG

Acute phase

Detect acute or past VZV infection

Complete Blood Count

Initial workup

Assess immune status

Imaging Studies

MRI Brain/IAC

If diagnosis unclear

Rule out other causes, assess nerve

CT Temporal Bone

If complications suspected

Evaluate bony structures

Functional Tests

Audiometry

Initial and follow-up

Assess hearing loss degree

Electroneurography

After acute phase

Evaluate nerve function

Vestibular Testing

If vertigo prominent

Assess balance function

Differential Diagnosis

Condition	Key Distinguishing Features	Diagnostic Tests
Bell's Palsy	No vesicular rash, less severe pain, often idiopathic	Clinical diagnosis, HSV PCR may be positive
Acoustic Neuroma	Gradual onset, no rash, progressive hearing loss	MRI with gadolinium
Stroke (Central)	Forehead sparing, other neurological signs	CT/MRI brain, neurological assessment
Temporal Bone Fracture	History of trauma, hemotympanum, CSF leak	CT temporal bone
Lyme Disease	Endemic area, erythema migrans, bilateral possible	Lyme serology, clinical history

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