Case Study for treatment considerations for patients with Ramsay Hunt Syndrome

Abstract

"Ramsay Hunt syndrome (RHS) is a rare neurological disorder characterized by paralysis of the facial nerve caused by varicella zoster virus [3]." RHS is not a diagnosis typically seen in physical therapy. Manifesting similar to Bell's palsy on inception, RHS affects the cranial nerves (CN) with a variety of symptoms that may include: tinnitus, hearing loss, difficulty with speech or swallowing, loss of balance, inner ear involvement, extremity weakness or involvement, and a myriad of other possible symptoms. The purpose of this case study is to enlighten therapists and readers to the possible treatment considerations of the side effects caused by RHS based on the patient's symptoms and presentation. Patient SC initially presented with shingles to cranial nerves (CN) V, VII, and VIII following a week long headache. Physical therapy (PT) was prescribed in hopes of facilitating and/or alleviating his symptoms of decreased balance and facial control. He responded very well to balance and vestibular training to regain control of his lower extremities to ambulate without his single point cane (SPC). He regained minimal control of his facial musculature with continued tinnitus. It is interesting to point out that he did respond well to electrical stimulation of his facial and cervical musculature while in the clinic with poor to fair carryover after and between treatment sessions.