Ramsay Hunt syndrome (Otic herpes zoster)

The medical field identifies numerous syndromes that carry various symptoms and causes. One such syndrome is the facial nerve paralysis accompanying herpes zoster of the auricle, described by American neurologist James Ramsay Hunt. This condition is associated with several unpleasant and painful symptoms that not only affect the ear area but can also extend to other parts of the face.

The causes of Ramsay Hunt syndrome

Ramsay Hunt syndrome is caused by the varicella zoster herpes virus, which attacks the nerve cells located in the middle ear. The primary infection, which causes chickenpox, typically occurs in childhood, and the virus remains dormant in the body. The reactivation of the virus, which occurs due to immune system weakness, manifests as shingles on the skin while also causing pain along the affected nerves.

What makes Ramsay Hunt syndrome unique is that during the course of the disease, not only the skin but also the nervous system becomes affected. In addition to the classic symptoms of shingles, paralysis of the facial nerve, which controls the mimetic muscles, also appears. This phenomenon is particularly characteristic, as it is included in the diagnostic criteria for the syndrome. Due to the involvement of the facial nerve, the disease may have a more severe course than other herpes infections that cause similar skin manifestations.

Symptoms of Ramsay Hunt syndrome

Ramsay Hunt syndrome presents a variety of symptoms, including herpes blisters on the auricle and ear canal, as well as ear pain. In addition to facial nerve paralysis, patients often experience tinnitus and hearing loss. When the disease manifests, the eyes may also be affected, leading to ocular symptoms such as nystagmus.

When diagnosing the syndrome, it is important to differentiate it from other diseases that cause similar symptoms, such as inner ear inflammation or trigeminal neuralgia. In the case of Ramsay Hunt syndrome, the pain is typically severe and unilateral, making accurate diagnosis challenging. In children, special attention must be paid to ensure that the absence of blisters on the auricle does not interfere with diagnosis, as the syndrome can also occur in childhood.

Diagnosis and treatment of Ramsay Hunt syndrome

The diagnosis of Ramsay Hunt syndrome is generally based on clinical examinations, but virological tests may also be used for more accurate results. The occurrence of the disease is usually more common among middle-aged and older adults, and the prognosis is not favorable, especially if the facial nerve is involved. The appearance of facial paralysis and chronic pain is common, which deteriorates the quality of life for patients.

During treatment, systemic antiviral agents, such as acyclovir, and steroids are recommended. These medications should be started as soon as possible, preferably within the first three days of symptom onset, for a more effective outcome. To protect the eyes, artificial tears and nighttime eye coverings may also be necessary to avoid corneal injuries.

The prognosis of Ramsay Hunt syndrome is influenced by several factors, such as the patient’s age, gender, and existing health conditions like diabetes or hypertension. Early diagnosis and appropriate medical intervention are crucial for the effectiveness of the treatment.