Clinical Features and Prognosis of Facial Palsy and Hearing Loss in Patients With Ramsay Hunt Syndrome

Abstract

Ramsay Hunt syndrome, a late manifestation of varicella-zoster virus infection, occurs when the virus reactivates, infects, and produces an inflammatory reaction in the seventh cranial nerve geniculate ganglion. The detection is made clinically on the basis of the following three features: facial nerve palsy, the presence of characteristic herpetic vesicles around the mouth, and pain in the ear. However, it is often diagnosed quite late and sometimes even missed, increasing the chances of complications that have long-term effects. The two significant complications following the development of Ramsay Hunt syndrome are facial nerve palsy and hearing impairment. Ramsay Hunt syndrome is among the principal causes of facial nerve palsy, implicated in around 2-10% of all cases. While hearing loss though prevalent, is a less common complication than facial palsy. This review aimed to analyze the clinical presentation and prognostic features of the complications of Ramsay Hunt syndrome mentioned above, that is, hearing loss and facial nerve palsy. It was seen that while the association of Ramsay Hunt syndrome with facial nerve palsy has been studied quite extensively, the literature on hearing loss as a sequela is quite lacking. The course and outcome of facial nerve palsy is determined by the early clinical picture, while the otological symptoms rely on the extent of nerve involvement. Early diagnosis and treatment go a long way in preventing these complications and increasing the chances of complete recovery. Treatment options most commonly studied included antiviral drugs such as acyclovir, steroids, and anti-inflammatory agents.

Association between Serum Varicella-Zoster Virus IgM and IgG and Prognosis of Ramsay Hunt Syndrome

“…RHS accounts for approximately 6.1% of all facial paralysis cases, and its prognosis is worse than that of Bell's palsy [2]. This is thought to be due to the close association between the VZV infection and reactivation of preexisting VZV in the geniculate ganglion of the facial nerve, which leads to severe inflammation [3].…”

Atypical Presentation of Ramsay Hunt Syndrome without Facial Palsy in an Immunocompetent Senegalese Adulte Patient

“…It is caused by reactivation of VZV in the geniculate ganglion of the facial nerve. The most common clinical symptoms are a combination of peripheral facial palsy, a painful erythematous vesicular rash affecting the outer and inner ear, and otalgia[3].…”