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Ramsay Hunt syndrome

Last reviewed: 5 Oct 2024
Last updated: 01 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • sudden-onset (<72 hours) unilateral facial weakness
  • ipsilateral severe ear/facial pain
  • ipsilateral vesicular rash
  • absence of constitutional symptoms
Full details

Other diagnostic factors

  • dry eye
  • vertigo
  • hearing loss
  • tinnitus
  • epiphora
  • altered taste
  • oral lesions
  • keratitis
Full details

Risk factors

  • prior exposure to varicella zoster virus (VZV)
  • age >50 years
  • immunosuppression
  • recent physiological stressor
  • female sex
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
  • varicella zoster virus (VZV) polymerase chain reaction (PCR)
Full details

Tests to consider

  • electroneurography (evoked electromyography)
  • MRI head and neck with contrast
  • serology for Borrelia burgdorferi
Full details

Treatment algorithm

ACUTE

acute symptoms

ONGOING

chronic symptoms

Contributors

Authors

Jonas R. Miller, MD

Facial Plastic and Reconstructive Surgery Fellow Otolaryngology-Head & Neck Surgery

UNC Facial Nerve Center

University of North Carolina-Chapel Hill

Chapel Hill

NC

Disclosures

JRM declares that he has no competing interests.

Matthew Q. Miller, MD

Assistant Professor Otolaryngology-Head and Neck Surgery

Director UNC Facial Nerve Center

University of North Carolina-Chapel Hill

Chapel Hill

NC

Disclosures

MQM is a paid consultant for Checkpoint Surgical, Inc.

Peer reviewers

Douglas J. Lanska, MD, MS, MSPH

Honorary Fellow

Department of Neurology

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

DJL declares that he has no competing interests.

Mervi Kanerva, MD, PhD

​Associate Professor

Senior ENT Consultant

Helsinki University Hospital

Helsinki

Finland

Disclosures

MK declares that she has no competing interests.

  • Ramsay Hunt syndrome images
  • Differentials

    • Bell’s palsy
    • Malignant facial nerve tumor
    • Benign facial nerve tumor (e.g., facial nerve schwannoma)
    More Differentials
  • Guidelines

    • S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia
    More Guidelines
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