Ramsay-Hunt syndrome generally starts with a 1- to 3-day prodrome of otalgia and ipsilateral facial paralysis followed by development of herpetic vesicles on the face just anterior to the tragus and various parts of the ear including the auricle, external ear canal, and tympanic membrane. Vesicles may also appear on the mouth and anterior two-thirds of the tongue. Evolution of disease may differ between age groups; in children, the vesicles may appear several days after the facial paralysis. Over the course of a week, the vesicles become pustules, and then ulcerate to form crusts. The lesions heal within weeks and may result in scarring. Other symptoms can include tinnitus, hearing loss, vertigo, hyperacusis, nystagmus, nausea, vomiting, taste impairment, lesions of the oral mucosa, dry mouth, and dry eyes. Cerebrovascular accidents have been associated with zoster.
Diagnosis is primarily clinical and is based on a combination of facial palsy, otalgia, and vesicles on the pinna or oral mucosa. Treatment is empiric and involves the use of high-dose corticosteroids and antiviral therapy. Ramsay-Hunt syndrome is less common than Bell palsy (idiopathic facial palsy), tends to cause more severe paralysis, and has a worse prognosis for facial nerve recovery (especially in children). Only 10% of patients with complete facial paralysis are totally cured. Prognosis for associated hearing loss is very good, with only around 5% of patients having residual impairment.
Related topics: herpes zoster, varicella
B02.21 – Postherpetic geniculate ganglionitis
21954000 – Herpes zoster auricularis
- Allergic contact dermatitis
- Bullous fixed drug eruption
- Eczema herpeticum
- Herpes simplex virus infection
- Insect bites
- Irritant contact dermatitis
- Poxviruses (cowpox, monkeypox)
- Pyoderma gangrenosum
- Varicella infection (primary or disseminated)
- Zoster sine herpete (in patients without rash)
- During the prodromal phase, Ramsay-Hunt Syndrome may present as Bell palsy with otalgia.