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Published in: European Archives of Oto-Rhino-Laryngology 4/2020

Open Access 01-04-2020 | Facial Palsy | Miscellaneous

Ramsay Hunt syndrome: characteristics and patient self-assessed long-term facial palsy outcome

Authors: Mervi Kanerva, Sanna Jones, Anne Pitkaranta

Published in: European Archives of Oto-Rhino-Laryngology | Issue 4/2020

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Abstract

Purpose

To explore the characteristics, medical treatments, and long-term facial palsy outcome in Ramsay Hunt syndrome.

Methods

Patient questionnaire including self-assessment of long-term facial palsy outcome and retrospective chart review. Initial facial palsy grade was compared to self-assessed or patient record stated palsy outcome. Occurrence of different characteristics (blisters, hearing loss, vertigo, etc.) of the syndrome were assessed.

Results

Altogether 120 patients were included of which 81 answered the questionnaire. All but one patient had received virus medication (aciclovir, valaciclovir), and half received simultaneous corticosteroids. If the medication was started within 72 h of Ramsay Hunt diagnosis, facial palsy recovered totally or with only slight sequelae in over 80% of the patients. Only a minority of the patients experienced varicella blisters simultaneously with facial palsy, blisters more often preceded or followed the palsy. Approximately 20% of the patients had their blisters in hidden places in the ear canal or mouth.

Conclusions

The long-term outcome of facial palsy in medically treated Ramsay Hunt syndrome was approaching the outcome of Bell’s palsy. It is crucial to ask and inform the patient about the blisters and look for them since, more often than not, the blisters precede or follow the palsy and can be in areas not easily seen.
Literature
1.
go back to reference Shim HJ, Jung H, Park DC, Lee JH, Yeo SG (2011) Ramsay Hunt syndrome with multicranial nerve involvement. Acta Otolaryngol 131(2):210–215CrossRef Shim HJ, Jung H, Park DC, Lee JH, Yeo SG (2011) Ramsay Hunt syndrome with multicranial nerve involvement. Acta Otolaryngol 131(2):210–215CrossRef
2.
go back to reference Sweeney CJ, Gilden DH (2001) Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 71:149–154CrossRef Sweeney CJ, Gilden DH (2001) Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 71:149–154CrossRef
3.
go back to reference Aizawa H, Ohtani F, Furuta Y, Sawa H, Fukuda S (2004) Variable patterns of varicella-zoster virus reactivation in Ramsay Hunt syndrome. Med Virol 74(2):355–360CrossRef Aizawa H, Ohtani F, Furuta Y, Sawa H, Fukuda S (2004) Variable patterns of varicella-zoster virus reactivation in Ramsay Hunt syndrome. Med Virol 74(2):355–360CrossRef
4.
go back to reference Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Genovese E, Monzani D, Presutti L (2012) Herpes zoster oticus: a clinical model for a transynaptic, reflex pathways, viral transmission hypotheses. Neurosci Res 74(1):7–9CrossRef Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Genovese E, Monzani D, Presutti L (2012) Herpes zoster oticus: a clinical model for a transynaptic, reflex pathways, viral transmission hypotheses. Neurosci Res 74(1):7–9CrossRef
5.
go back to reference Kim YH, Chang MY, Jung HH et al (2010) Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy. Laryngoscope 120(11):2270–2276CrossRef Kim YH, Chang MY, Jung HH et al (2010) Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy. Laryngoscope 120(11):2270–2276CrossRef
6.
go back to reference Peitersen E (2002) Bell's palsy: the spontaneous course of 2500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 549:4–30CrossRef Peitersen E (2002) Bell's palsy: the spontaneous course of 2500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 549:4–30CrossRef
7.
go back to reference Devriese PP, Moesker WH (1988) The natural history of facial paralysis in herpes zoster. Clin Otolaryngol Allied Sci 13:289–298CrossRef Devriese PP, Moesker WH (1988) The natural history of facial paralysis in herpes zoster. Clin Otolaryngol Allied Sci 13:289–298CrossRef
8.
go back to reference Robillard RB, Hilsinger RL Jr, Adour KK (1986) Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 95:292–297CrossRef Robillard RB, Hilsinger RL Jr, Adour KK (1986) Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 95:292–297CrossRef
9.
go back to reference Uscategui T, Doree C, Chamberlain IJ, Burton MJ (2008) Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 4:006851 Uscategui T, Doree C, Chamberlain IJ, Burton MJ (2008) Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 4:006851
10.
go back to reference Uscategui T, Doree C, Chamberlain IJ, Burton MJ (2008) Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 3:006852 Uscategui T, Doree C, Chamberlain IJ, Burton MJ (2008) Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 3:006852
11.
go back to reference de Ru JA, van Benthem PP (2011) Combination therapy is preferable for patients with Ramsay Hunt syndrome. Otol Neurotol 32(5):852–855CrossRef de Ru JA, van Benthem PP (2011) Combination therapy is preferable for patients with Ramsay Hunt syndrome. Otol Neurotol 32(5):852–855CrossRef
12.
go back to reference Whitley RJ (2009) A 70-year-old woman with shingles: review of herpes zoster. JAMA 302(1):73–80CrossRef Whitley RJ (2009) A 70-year-old woman with shingles: review of herpes zoster. JAMA 302(1):73–80CrossRef
13.
go back to reference Bean B, Braun C, Balfour HH Jr (1982) Acyclovir therapy for acute herpes zoster. Lancet 2(8290):118–121CrossRef Bean B, Braun C, Balfour HH Jr (1982) Acyclovir therapy for acute herpes zoster. Lancet 2(8290):118–121CrossRef
14.
go back to reference Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N (1997) Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: Significance of early diagnosis and treatment. Ann Neurol 41:353–357CrossRef Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N (1997) Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: Significance of early diagnosis and treatment. Ann Neurol 41:353–357CrossRef
15.
go back to reference House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146–147CrossRef House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146–147CrossRef
16.
go back to reference Neely JG, Cherian NG, Dickerson CB, Nedzelski JM (2010) Sunnybrook facial grading system: reliability and criteria for grading. Laryngoscope 120(5):1038–1045PubMed Neely JG, Cherian NG, Dickerson CB, Nedzelski JM (2010) Sunnybrook facial grading system: reliability and criteria for grading. Laryngoscope 120(5):1038–1045PubMed
17.
go back to reference Kanerva M, Jonsson L, Berg T et al (2011) Sunnybrook and House–Brackmann systems in 5397 facial gradings. Otolaryngol Head Neck Surg 144(4):570–574CrossRef Kanerva M, Jonsson L, Berg T et al (2011) Sunnybrook and House–Brackmann systems in 5397 facial gradings. Otolaryngol Head Neck Surg 144(4):570–574CrossRef
18.
go back to reference Uri N, Greenberg E, Kitzes-Cohen R, Doweck I (2003) Acyclovir in the treatment of Ramsay Hunt syndrome. Otolaryngol Head Neck Surg 129(4):379–381CrossRef Uri N, Greenberg E, Kitzes-Cohen R, Doweck I (2003) Acyclovir in the treatment of Ramsay Hunt syndrome. Otolaryngol Head Neck Surg 129(4):379–381CrossRef
19.
go back to reference Kinishi M, Amatsu M, Mohri M (2001) Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Auris Nasus Larynx 28:223–226CrossRef Kinishi M, Amatsu M, Mohri M (2001) Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Auris Nasus Larynx 28:223–226CrossRef
20.
go back to reference Zainine R, Sellami M, Charfeddine A, Beltaief N, Sahtout S, Besbes G (2012) Ramsay Hunt syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 129(1):22–25CrossRef Zainine R, Sellami M, Charfeddine A, Beltaief N, Sahtout S, Besbes G (2012) Ramsay Hunt syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 129(1):22–25CrossRef
21.
go back to reference Coulson S, Croxson GR, Adams R, Oey V (2011) Prognostic factors in herpes zoster oticus (Ramsay Hunt syndrome). Otol Neurotol 32(6):1025–1030CrossRef Coulson S, Croxson GR, Adams R, Oey V (2011) Prognostic factors in herpes zoster oticus (Ramsay Hunt syndrome). Otol Neurotol 32(6):1025–1030CrossRef
22.
go back to reference Kim HJ, Jung J, Kim SS, Byun JY, Park MS, Yeo SG (2017) Comparison of acyclovir and famciclovir for Ramsay Hunt syndrome. Otol Neurotol 38(5):754–758CrossRef Kim HJ, Jung J, Kim SS, Byun JY, Park MS, Yeo SG (2017) Comparison of acyclovir and famciclovir for Ramsay Hunt syndrome. Otol Neurotol 38(5):754–758CrossRef
23.
go back to reference Engström M, Berg T, Stjernquist-Desatnik A et al (2008) Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 7:993–1000CrossRef Engström M, Berg T, Stjernquist-Desatnik A et al (2008) Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 7:993–1000CrossRef
24.
go back to reference Shin DH, Kim BR, Shin JE, Kim CH (2016) Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol 273(7):1739–1743CrossRef Shin DH, Kim BR, Shin JE, Kim CH (2016) Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol 273(7):1739–1743CrossRef
25.
go back to reference Wayman DM, Pham HN, Byl FM, Adour KK (1990) Audiological manifestations of Ramsay Hunt syndrome. J Laryngol Otol 104(2):104–108CrossRef Wayman DM, Pham HN, Byl FM, Adour KK (1990) Audiological manifestations of Ramsay Hunt syndrome. J Laryngol Otol 104(2):104–108CrossRef
26.
go back to reference Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N (2000) Ramsay Hunt syndrome in children. Ann Neurol 48:254–256CrossRef Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N (2000) Ramsay Hunt syndrome in children. Ann Neurol 48:254–256CrossRef
Metadata
Title
Ramsay Hunt syndrome: characteristics and patient self-assessed long-term facial palsy outcome
Authors
Mervi Kanerva
Sanna Jones
Anne Pitkaranta
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 4/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-05817-y

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