herpes zoster oticus

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The Ramsay Hunt Syndrome is characterised by sensorineural deafness, vertigo and facial paralysis following Herpes Zoster infection. The patient is usually elderly.

Herpes zoster infects the geniculate ganglion, more rarely the IXth and Xth nerves and, very occasionally, nerves V, VI or XII.

Recovery of facial nerve function is less likely than in Bell's palsy.

The prognosis can be improved by treatment with acyclovir.

  • standard first-line treatment for herpes zoster infections at sites in the body other than the ear is the antiviral agent acyclovir, which is given either intravenously or orally. Other antiviral agents that may be prescribed include valacyclovir, famcyclovir or brivudin (1)

A systematic review considered the use of corticosteroids with acyclovir (2):

  • did not identify any randomised controlled trials that assess the effects of using corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome. .. If they were entirely harmless and free of adverse effects it might be possible to argue in favour of their use in patients with Ramsay Hunt syndrome, even in the absence of evidence of effectiveness

A more recent review (3) states:

  • early treatment with a combination of acyclovir and prednisone is reported to be effective to treat Ramsay Hunt syndrome (3). However it is noteworthy that the two studies referenced for justification of this treatment strategy preceded the publication date of the Cochrane review (2)


Last edited 03/2021 and last reviewed 04/2021