Ramsay Hunt Syndrome – A Diagnostic Dilemma

Ramsay Hunt Syndrome (RHS), also called Herpes Zoster Oticus (HZO), is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. The classic triad consists of otalgia, vesicles in the auditory canal and ipsilateral facial paralysis [1]. Facial palsy, which occurs annually in 30 of 100 000 individuals in the general population, may have various causes, ranging from head trauma to an idiopathic episode [2]. Although RHS is rare, it is the second most common cause of facial paralysis (after Bell’s palsy) with non -traumatic peripheral facial paralysis. Early diagnosis and accurate treatment for patients with idiopathic facial palsy (Bell palsy) and Ramsay Hunt syndrome may accelerate recovery and prevent possible complications. Without treatment, full recovery of the facial paralysis occurs in as little as 20% of cases; this is much improved if treatment is started within 72 hours [3]. Among the agents most frequently used to treat these conditions are steroids, antiviral agent’s vasodilators, and multivitamins. Due to the anti-inflammatory effect of steroids, an enhanced recovery can be achieved in patients with steroid treatment in Bell palsy and Ramsay Hunt syndrome [2]. In addition, the treatment for patients with Ramsay Hunt with antiviral agents may prevent disease progression and improve prognosis by inhibiting the spread of herpes zoster virus [4,5].