Professionals
What is Ramsay Hunt Syndrome?
Ramsay Hunt Syndrome, also known as herpes zoster oticus, is a leading cause of facial paralysis caused by reactivation of the varicella zoster virus (aka the chicken pox virus) affecting the facial nerve. The classic presentation of Ramsay Hunt Syndrome includes sudden onset (within 24-72 hours) facial paralysis, a blistering rash of the ear, and hearing loss and/or dizziness. Some patients will experience facial paralysis and hearing loss or dizziness without ever getting a rash (aka zoster sine herpete). The main distinguishing features between Bell’s palsy and Ramsay Hunt Syndrome include:
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A painful blistering rash of the ear is consistent with Ramsay Hunt Syndrome
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“Room spinning” dizziness is consistent with Ramsay Hunt Syndrome
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While Bell’s palsy patients often have discomfort around the ear, this pain is not triggered by touch or manipulation of the ear like the pain of Ramsay Hunt Syndrome. The pain of Ramsay Hunt Syndrome is more severe than that of Bell’s palsy.
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While patients with Bell’s palsy and RHS frequently have sensitivity to loud noises, hearing loss is consistent with Ramsay Hunt Syndrome
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Treatment Options
Initial Treatment
Recommend starting treatment upon initial evaluation of the patient. Best outcomes are noted when treatment is started within 72 hours of initial symptom onset.
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For all patients:
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Steroids
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60 mg of Prednisone daily for 7-10 days
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Antivirals
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1000 mg Valtrex TID for 7 days
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Refer to Otolaryngology
For patients with incomplete eye closure:
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Eye Protection
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Drops (ex: Refresh Tears) Q2H and PRN
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Eye ointment (ex: Refresh PM) nightly
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Night time care: patients should be instructed to place ointment in the eye, physically close the eye and then tape the upper eyelid to the upper cheek to keep the eye lubricated and closed while asleep.
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For those with a red or irritated eye - consider referral to ophthalmology
Self-Help: https://www.facialpalsy.org.uk/support/self-help-videos/
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