Ramsay Hunt Syndrome

Ramsay Hunt syndrome, also known as herpes zoster oticus or geniculate zoster, is a rare condition that manifests as a complication of the Varicella zoster virus (VZV) that arises in the geniculate ganglion of cranial nerve CVII. Early stages of the VZV infection cause fever and diffuse vesicular rash, a condition that is commonly referred to as chickenpox. After the initial infection, the virus will often remain dormant within various ganglion in the body. The zoster infection is caused by a reactivation of the virus. This can produce linear vesicular rashes along the nerve's distribution, typically involving a single dermatome. The distribution and associated symptoms depend on the nerve involved, and there are many different syndromes associated with this virus. Less than 1% of the cases of zoster involve the facial nerve and result in Ramsay Hunt syndrome. The syndrome is characterized by a classic triad of ipsilateral facial paralysis, otalgia, and vesicles in the auditory canal. Additional symptoms include changes in taste along the anterior two-thirds of the tongue, dry eye, hearing loss, tinnitus, and/or vertigo can be seen with the involvement of the vestibulocochlear nerve. Vesicles often develop after the onset of neurologic symptoms. Vesicles typically appear near the ear but can be seen along the affected side of the face, hard palate, and tongue.