Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T08:20:12.533Z Has data issue: false hasContentIssue false
  • English
  • Français

Ramsay Hunt syndrome presenting as simple otitis externa

Published online by Cambridge University Press:  21 May 2015

Daniel Kim  and
Munsif Bhimani
Daniel Kim*
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont.; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
Munsif Bhimani
Affiliation:
Department of Emergency Medicine, London Health Sciences Centre and Division of Emergency Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
*
1912-633 Bay St., Toronto ON M5G 2G4; dkim000@gmail.com

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion, causing otalgia, auricular vesicles and peripheral facial paralysis. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. We report the case of a patient who was diagnosed with simple otitis externa after presenting to the emergency department (ED) with a 3-day history of right-sided otalgia. Her condition subsequently evolved to include right-sided auricular vesicles and right-sided facial weakness. She presented to the ED again after 2 days and was correctly diagnosed with Ramsay Hunt syndrome. We describe the clinical presentation, diagnostic findings and management of this uncommon but important entity.

Keywords

Ramsay Hunt syndromevaricella zoster virusherpes zoster
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 3 , May 2008 , pp. 247 - 250
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Hunt, JR. On herpetic inflammations ofthe geniculate ganglion: a new syndrome and its complications. J Nerv Ment Dis 1907; 24:73–96.Google Scholar
2.Head, H, Campbell, AW, Kennedy, PG. The pathology of herpes zoster and its bearing on sensory localization. Rev Med Virol 1997;7:131–43.Google Scholar
3.Takasu, T, Furuta, Y, Sato-Matsumura, KC, et al. Detection of varicella-zoster virus DNA in human geniculate ganglia by polymerase chain reaction. J Infect Dis 1992;166:1157–9.Google Scholar
4.Gnann, JW Jr, Whitley, RJ. Herpes zoster. N Engl J Med 2002;347:340–6.Google Scholar
5.Sterling, JC, Kurtz, JB. Viral infections. In: Champion, RH, Burton, JL, Burns, DA, Brethnach, SM, editors. Textbook of dermatology, Rook/Wilkinson/Ebling. vol 2. 6th ed. Oxford (UK): Blackwell Science; 1998. p. 1015–21.Google Scholar
6.Ragozzino, MW, Melton, LJ III, Kurland, LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982;61:310–6.Google Scholar
7.Adour, KK. Otological complications ofherpes zoster. Ann Neurol 1994;35(suppl):S62–4.Google Scholar
8.Devriese, PP, Moesker, WH. The natural history of facial paralysis in herpes zoster. Clin Otolaryngol 1988;13:289–98.Google Scholar
9.Sweeney, CJ, Gilden, DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001;71:149–54.Google Scholar
10.Jonsson, L, Tien, R, Engstrom, M,et al. Gd-DPTA enhanced MRI in Bell’s palsy and herpes zoster oticus: an overview and implications for future studies. Acta Otolaryngol 1995;115:577–84.Google Scholar
11.Murakami, S, Honda, N, Mizobuchi, M, et al. Rapid diagnosis of varicella zoster virus infection inacute facial palsy. Neurology 1998;51:1202–5.Google Scholar
12.Murakami, S, Nakashiro, Y, Mizobuchi, M, et al. Varicella-zoster virus distribution in Ramsay Huntsyndrome revealed by polymerase chain reaction. Acta Otolaryngol 1998;118:145–9.Google Scholar
13.Adour, KK, Byl, FM, Hilsinger, RL Jr, et al. The true nature of Bell’s palsy: analysis of 1000 consecutive patients. Laryngoscope 1978;88:787–801.Google Scholar
14.Agius, AM, Pickles, JM, Burch, KL. A prospective study of otitis externa. Clin Otolaryngol 1992;17:150–4.Google Scholar
15.Merskey, H, Bogduk, N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Seattle (WA): IASP Press; 1994. p. 59–71.Google Scholar
16.Yeo, SW, Lee, DH, Jun, BC, et al. Analysis of prognostic factors in Bell’s palsy and RamsayHunt syndrome. Auris Nasus Larynx 2007;34:159–64.Google Scholar
17.Murakami, S, Hato, N, Horiuchi, J, et al. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment. Ann Neurol 1997;41:353–7.Google Scholar
18.Kinishi, M, Amatsu, M, Mohri, M, et al. Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Auris Nasus Larynx 2001;28:223–6.CrossRefGoogle ScholarPubMed
19.Jelks, GW, Smith, B, Bosniak, S. The evaluation and management of the eye in facial palsy. Clin Plast Surg 1979;6:397–419.Google Scholar