Ramsay Hunt Syndrome

 Q: Which of the following is NOT a part of the triad in Ramsay Hunt syndrome? 

A) ipsilateral facial paralysis 

B) ear pain 

C) vesicles in auditory canal or auricle 

D) vertigo

Answer: D

Ramsay Hunt syndrome is actually an otologic manifestation of Herpes. Its proper scientific name is herpes zoster oticus with facial palsy. It is famous for its triad of 

• ipsilateral facial paralysis 
• ear pain, and 
• vesicles in the auditory canal or on the auricle 

There can be many other symptoms of this syndrome that are not part of the triad but are frequently encountered. These include ipsilateral altered taste perception, ipsilateral tongue lesions, decreased or increased (hyperacusis) hearing, tinnitus, lacrimation and vertigo. 

Ramsay Hunt syndrome occurs due to herpes reactivation of latent Varicella Zoster Virus (VZV) in the geniculate ganglion, with spread of infection to the 8th cranial nerve. It has also been described as a part of multiple cranial nerves VZV. 

Another objective of this question is to highlight its worse symptomatic presentation and outcome when compared to Bell's palsy. It has fewer chances of recovery.

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References:

1. Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol. 2002 Oct;116(10):844-8. doi: 10.1258/00222150260293691. PMID: 12437843. 

2. Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. 2012 May-Jun;33(3):313-8. doi: 10.1016/j.amjoto.2011.10.001. Epub 2011 Nov 8. PMID: 22071033. 

3. Jeon Y, Lee H. Ramsay Hunt syndrome. J Dent Anesth Pain Med. 2018;18(6):333-337. doi:10.17245/jdapm.2018.18.6.333 

4. Lee DH, Chae SY, Park YS, Yeo SW. Prognostic value of electroneurography in Bell's palsy and Ramsay-Hunt's syndrome. Clin Otolaryngol 2006; 31:144. 

5. Uscategui T, Dorée C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 2008; :CD006851.