Ramsay Hunt Syndrome

Herpes Zoster Oticus

Causes of Ramsay Hunt Syndrome?

Varicella zoster virus is actually a microorganism that belongs to the herpes virus family and is the causative agent of shingles. Sometimes, it can be hidden in the nerve cells and wait for the body resistance of the patients to decrease and it can cause infection in the matching places in the nerve traces with reactivation. This virus is also the virus that causes chickenpox.

The patient I shared with you here had skin infections, facial paralysis, earache, and ear discharge after vesicular lesions that appeared in the trace of the left facial nerve. The patient applied to another clinic with the complaints of facial wounds that appeared 10 days ago, pain and warmth in the ear region, and facial paralysis, decreased movement in the left half. There, the patient was given oral antiviral medicine, vitamin eye moisturizing gel and local antiviral cream. Since the patient's eyes remained open during sleep, it was recommended to use moisturizing tears or moisturizing eye gel especially during sleep in order to protect the cornea, and to cover his eyes with a clean gauze if necessary.

If you look at the photos above and examine the photos below, you can see the widespread lesions on the patient's face, possibly vesicular lesions. After the diagnosis, bacterial infections and deep infection under the skin and skin appeared, causing tissue destruction. In the examination of the patient, left peripheral facial paralysis, widespread lesions in the areas matching the left facial nerve trace, and herpetic vesicular lesions in the left external auditory canal were found. Chronic otitis media was detected in the left middle ear due to previous middle ear infections, and the eardrum was found to be perforated. In addition, local antibiotic antiseptic and cortisone-containing drops were added to the treatment. In the examination performed 10 days later, it was observed that the severity of the left peripheral facial paralysis decreased, the pain and burning sensation in the ear disappeared, and there were dark-colored wound healing areas on the skin. In all the photos you shared here, it is seen that all the skin sulcus of the left half of the patient are faint. In addition to the patient, physiotherapy treatment was recommended for the muscles of the last face and for the purpose of auxiliary myofunctional therapy. It was given with extractor in order to reduce the stars on the face, and the patient was advised to use vitamins by mouth. Oral cortisone can sometimes be used in addition to the treatment.

Ramsay Hunt Syndrome Symptoms

The main findings in Ramsey hunt syndrome are the presence of vesicular lesions in the external auditory canal and on the tracing of the facial nerve, facial paralysis, sometimes dizziness, nausea, vomiting, subfebrile fever, oropharynx, hypopharynx, and similar lesions on the skin in the larynx region.

Ramsay Hunt Syndrome - Disease Course

Usually, patients may experience a burning and stinging pain in and around the ear, usually in the period following viral symptoms. The auricle may be reddened or vesicular red lesions may appear on the inner side of the outer ear canal and the posterior part of the outer ear canal. Herpes lesions may appear after a few days, and herpes-like lesions usually occur on branches of the facial nerve. Sometimes patients may have herpes lesions behind the ear, near the shoulder, on the cheeks, tongue and pharynx. In addition, patients have a mild general malaise. Fever and swelling of the lymph nodes may occur. Peripheral facial palsy may not occur in all patients. Generally, the probability of peripheral facial paralysis is between 60 and 90 percent.

Generally, facial paralysis occurs 2-3 days after the appearance of vesicles, sometimes it can be delayed up to a week. In mild forums, there are no neurological symptoms in patients, while in severe forums, hearing loss, tinnitus, dizziness, balance disorder, vomiting, nausea and nystagmus may occur, and permanent tinnitus and hearing loss may occur .

In the literature, advanced age, presence of diabetes mellitus and hypertension are known as poor prognostic factors in the treatment of ramsay hunt syndrome.

Treatment of Ramsay Hunt Syndrome

Early diagnosis in the treatment of Ramsey hant syndrome is very important in preventing permanent nerve damage. Treatment of diseases that cause a decrease in the resistance of the underlying immune system, antiviral therapy for existing virus infection, cortisone therapy, oral vitamin therapy, and various physiotherapy to increase muscle activity can be recommended. The overall recovery rate is around 60 percent. Facial palsy, which usually occurs during ramsay hunt syndrome, does not heal as quickly as classical bell palsy. The increase in facial movements during the treatment shows that the success of the treatment will be high.

Ramsay Hunt Syndrome is an otolaryngological emergency in which early treatment is very important.