RAMSAY HUNT SYNDROME

Ramsay Hunt Syndrome is a variant of herpes zoster that involves the branch of the facial nerve located near the ears. A most common presentation is the ringing of the ears with the presence of herpetiform rashes and palsy of the facial nerve.

The causative agent of Ramsay Hunt syndrome is the varicella-zoster virus, and the same pathogen causes chickenpox

TYPES

  • Type 1- Also known as Ramsay Hunt cerebellar syndrome that presents as involuntary movements of the extremities that appear as myoclonic seizures. There is also progressive loss of balance, inconsistent memory and tremors.
  • Type 2- Recurrence of the herpes zoster and is called the herpes zoster oticus, presents as pain in the ear due to appearance of blisters in the ear canal, with visible lesions in the facial area.
  • Type 3- Also known as Hunt’s disease or artisan’s palsy that presents as a passing paralysis. It is the least common type of the 3.

SYMPTOMS

The initial symptom of the Ramsay Hunt syndrome include:

  • The appearance of pustules (pus-filled induration in the skin)
  • Drooping of one side of the face especially the affected side is visible
  • Patients also complain of numbness and loss of sensation of the area where the pustules have developed.
  • Redness and erythema with rashes on the perioral region, hard palate and tonsils
  • Ear pain
  • Dysgeusia, ageusia, loss or altered taste buds
  • Inability to completely close the eyes on the affected side
  • Since the facial nerve is concerned, there is a tendency that speech will be affected, some present with difficulty in phonation, slurring of speech (this must be differentiated from the slurring caused by cerebrovascular accident)

DIAGNOSIS

The appearance of the lesions of shingles is very typical that the clinician can diagnose it at first sight. However, the following data serve its importance in arriving at the correct diagnosis.

  • History of the patient
  • Exposure to persons who have chickenpox
  • Past medical history: Important in assessing for the presence of comorbidities
  • Patient’s age when he/she had chickenpox
  • Presence or absence of cloudy discharge in the ears
  • Some clinicians do aspiration of the fluid from the blisters and is sent to the 
  • laboratory for examination

TREATMENT

Household treatment remedy includes:

  • Use of mild, antiseptic soap to clean the area of the lesion.
  • Application of ice or a cold towel onto the area of the blister
  • Pain relievers such as ibuprofen, paracetamol.
  • In cases of incomplete closure of the eyelid due to facial nerve dysfunction, placing an ear patch over the affected eye, keeping it lubricated with artificial tears.

In-hospital treatment setting includes:

  • Drugs that have an antiviral activity such as acyclovir, famciclovir, ganciclovir.
  • Steroids – Works synergistically with antiviral drugs to reduce the inflammation and pain, especially in the area supplied by the facial nerve.
  • Drugs that control anxiety- they help reduce imbalance and controls dizziness.

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