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Ramsay Hunt Syndrome – A Diagnostic Dilemma

Journal of Otolaryngology-ENT Research
Pirabu Sakthivel, Department of Otorhinolaryngology & Head and Neck surgery, All India Institute of Medical Sciences, India


Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. Ramsay Hunt Syndrome (RHS) is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. It is also accompanied by other frequent symptoms like tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus due to the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal.Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction.

We describe a 23 year old female who was initially misdiagnosed as Bell’s palsy and later developed vesicles on the pinna which led to a diagnosis of RHS and successfully treated with acyclovir and steroids.


Facial palsy, Ramsay hunt syndrome, Varicella zoster, Herpes zoste, RHS, Varicella zoster virusl, Polymerase chain reaction, PCR