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

Abstract

Purpose To determine the long-term facial palsy outcome of Ramsay Hunt Syndrome by face-to-face grading by House-Brackmann Grading System, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System concomitantly. To compare the applicability of the grading scales. To compare patients' self-assessed facial palsy outcome results to gradings performed by the investigator. To compare the face-to-face assessed facial palsy outcome to the initial palsy grade. Methods Fifty-seven patients self-assessed their facial palsy outcome and came to a one-time follow-up visit. The palsy outcome was graded by one investigator using the three above-mentioned grading systems concomitantly. The median time from syndrome onset to follow-up visit was 6.6 years. Result A good long-term face-to-face assessed palsy outcome was enjoyed by 84% of the patients. Trying to assess only one House-Brackmann grade to represent the palsy outcome was impossible for most patients. Facial Nerve Grading System 2.0 worked better, but needed adjustments and certain sequelae findings needed to be neglected for it to be executable. The Sunnybrook system worked the best. Nearly 20% of the patients assessed themselves differently from the investigator: both better and worse. Conclusion The Sunnybrook scale was the most applicable system used. With antiviral medication, the outcome of facial palsy in Ramsay Hunt syndrome starts to resemble that of Bell's palsy and emphasizes the importance of recognizing the syndrome and treating it accordingly. The results give hope to patients instead of the gloomy prospects that have stigmatized the syndrome.

Facial palsy in children: long-term outcome assessed face-to-face and follow-up revealing high recurrence rate

“…HB failed to be executable with half of the patients that had any sequelae findings as was FNGS in a quarter of the cases. We have previously shown in our own studies [13,23,24] and many colleagues in theirs [14,15,25] that often the HB result is forced to be a compromise of voluntary muscle functions (forehead, eye, and mouth) since the recovery levels of different areas of the face can differ greatly. Additionally, resting symmetry and/or synkinesis findings that are in disagreement with the grade best representing the voluntary muscle function status must be ignored to be able to place the patient in only one HB grade.…”

Characteristics of and Prognosis for Facial Palsy in Patients With Otitis Media With ANCA-Associated Vasculitis (OMAAV)

“…The percentage of the patients with facial palsy in their clinical course and severity of palsy were investigated for all patients with OMAAV. Facial palsy was evaluated using the House–Brackmann facial grading system (HB) (9) by one well-trained otolaryngologist, with patients with Grade I or II at the last visit defined as having a good recovery and those with Grade I defined as having a total recovery (10). Afterwards, the patients were divided into two groups, namely those with (the facial palsy group) and those without facial palsy (non-palsy group), and the characteristics of the patients with facial palsy were investigated.…”

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

“…Subsequent viral multiplication in the keratinocytes results in the characteristic clinical signs of herpetiform-distributed vesicles [ 2 ]. The vestibulocochlear nerve (CN VIII), which results in hearing impairment, tinnitus, and dizziness, is usually affected in association with the facial nerve (CN VII) [ 3 ]. The disease usually presents as herpetic vesicles around the pinna or oral mucosa, otalgia, and facial nerve palsy [ 4 ].…”

“…Few people with this syndrome continue to have complete facial paralysis, but around half of them still have some facial motor impairment [ 9 - 11 ]. Even in one-third of cases of Ramsay Hunt syndrome, blisters appear preceded by facial paralysis, making it challenging to diagnose Ramsay Hunt syndrome at the time of onset of facial paralysis [ 3 ]. Bilateral signs, many inclusions of other cranial nerves, delayed progression, insufficient recovery within three months of initiation, or systemic symptoms raise the possibility of a nonviral etiology [ 12 ].…”