Herpes zoster oticus: A rare clinical entity

Abstract

Herpes zoster oticus also known as Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion causes otalgia, auricular vesicles, and peripheral facial paralysis. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Although secondary to Bell's palsy in terms of the cause of acute atraumatic peripheral facial paralysis, Ramsay Hunt syndrome, with incidence ranged from 0.3 to 18%, has a worse prognosis. Herpes zoster oticus accounts for about 12% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. The most advisable method to treat Ramsay Hunt syndrome is the combination therapy with acyclovir and prednisone but still not promising, and several prerequisites are required for better results. We present a case of 32-year-old man suffering from Ramsay Hunt syndrome with grade V facial palsy treated effectively with rehabilitation program, after the termination of the combination therapy of acyclovir and prednisone.

Ramsay Hunt Syndrome – A Diagnostic Dilemma

“…Facial paralysis usually develops within 1-2 weeks after the rash appears [2]. Facial palsy and zoster do not always appear simultaneously, and some patients with RHS exhibit facial palsy several days before as in our case or after the onset of zoster [8]. VZV also causes acute peripheral facial palsy with the absence of skin lesions; such cases are termed zoster sine herpete and are usually diagnosed using serological assays or polymerase chain reaction (PCR) [8,9].…”

“…RHS, which develops in 1% of patients with a herpes zoster infection, was first described by Ramsay Hunt in 1907 [7]. The primary etiologic agent of RHS is VZV but Bell's palsy, in contrast, has been attributed to herpes simplex virus type-1 [8]. RHS commences with the classical prodromal symptoms of pain, fever, and fatigue, 1-3 days in duration.…”

“…Importantly, no statistically significant outcome differences were noted between patients treated with intravenous or oral acyclovir. Because of increasing viral resistance to acyclovir, newer drugs, such as valacyclovir, famciclovir, penciclovir and brivudine, are being more commonly used [8].…”

Ramsay Hunt Syndrome: A Clinical Management Experience from a Secondary Care Public Hospital

“…1,2 The reactivation of varizella zoster virus (VZV), in a patient who was affected with chickenpox earlier can be the root cause for this condition. The microorganism may survive in inactivated stage for a long time in geniculate ganglia, which involves in the regulation of facial nerves.…”

Facial paralysis due to Ramsay Hunt syndrome - A rare condition

“…It is essential to refer patients to rehabilitation after the acute phase for motor physiotherapy, biofeedback and massage therapy. 2,4 Our patient received seven days of prednisone and acyclovir, and a request for physioterapy as soon as the pain improved. She progressed with complete resolution of the facial paralysis 30 days after onset of treatment and no hearing sequelae was observed.…”