Ramsay Hunt syndrome: characteristics and patient self-assessed long-term facial palsy outcome

Abstract

Purpose To explore the characteristics, medical treatments, and long-term facial palsy outcome in Ramsay Hunt syndrome. Methods Patient questionnaire including self-assessment of long-term facial palsy outcome and retrospective chart review. Initial facial palsy grade was compared to self-assessed or patient record stated palsy outcome. Occurrence of different characteristics (blisters, hearing loss, vertigo, etc.) of the syndrome were assessed. Results Altogether 120 patients were included of which 81 answered the questionnaire. All but one patient had received virus medication (aciclovir, valaciclovir), and half received simultaneous corticosteroids. If the medication was started within 72 h of Ramsay Hunt diagnosis, facial palsy recovered totally or with only slight sequelae in over 80% of the patients. Only a minority of the patients experienced varicella blisters simultaneously with facial palsy, blisters more often preceded or followed the palsy. Approximately 20% of the patients had their blisters in hidden places in the ear canal or mouth. Conclusions The long-term outcome of facial palsy in medically treated Ramsay Hunt syndrome was approaching the outcome of Bell's palsy. It is crucial to ask and inform the patient about the blisters and look for them since, more often than not, the blisters precede or follow the palsy and can be in areas not easily seen.

Ramsay Hunt syndrome: long-term facial palsy outcome assessed face-to-face by three different grading scales and compared to patient self-assessment

“…The patient number in this study was too small to draw statistically reliable conclusions whether the type or dosing of the used medication played any role in the outcome of FP. In our previous study [11], the outcome stayed the same as long as the medication was started within 72 h of the RHS onset. The outcome was worse with those receiving no medication or starting the medication over 72 h from RHS onset.…”

“…Patients were sent a questionnaire about their RHS [11]. They were asked to self-assess their RHS FP outcome and were invited to come to one follow-up visit, where their facial function was graded by the corresponding author with HB, FNGS, and SB concomitantly.…”

“…We have previously published the results of the retrospective chart study (120 patients) and the patient questionnaire study (81 patients): medical treatment, blister location and time to FP, hearing loss and its outcome, other adjoining symptoms, and outcome of FP on grounds of patient charts, and patient self-assessment [11]. In the current study, we concentrated on the face-to-face assessed long-term FP outcome of those 57 patients coming to the follow-up visit.…”

“…Even in one-third of RHS cases, blisters follow FP [10,11] making the diagnosis of RHS impossible at the time of FP onset. Clinicians must be alert to remember the syndrome and inform patients of this possibility.…”

Relato de caso: Síndrome de Ramsay Hunt

“…Além disso, a paciente realizou uma ressonância magnética de crânio que apresentou um discreto favorecimento a possibilidade de um processo inflamatório/infeccioso do nervo facial direito (neurite). A associação de alterações do pavilhão auricular e do conduto auditivo externo desde lado permite a inclusão de síndrome de Ramsay-Hunt no diagnostico diferencial (Donati et al, 2012;Kanerva et al, 2020). Apesar desse exame não ser critério para diagnóstico e nem o mais específico, ele é essencial para avaliar um processo infeccioso e até mesmo inflamatório do nervo para, juntamente com os exames laboratoriais para fechar o diagnóstico ou até mesmo para distinguir de outra patologia no diagnóstico diferencial (Pillar et al, 2016).…”