Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Ramsay Hunt Syndrome Treatment & Management

  • Author: Augusto A Miravalle, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
 
Updated: Oct 06, 2015
 

Medical Care

Corticosteroids and oral acyclovir are commonly used in the treatment of Ramsay Hunt syndrome. In one review, combined therapy using corticosteroids plus intravenous acyclovir did not show benefit over corticosteroids alone in promoting facial nerve recovery after 6 months. However, randomized clinical trials evaluating both therapies are required.[9]

Another study concluded that controlled-release oxycodone was safe and generally well tolerated in patients experiencing acute pain due to herpes zoster.[10]

Vestibular suppressants may be helpful if vestibular symptoms are severe.

As with Bell palsy, care must be taken to prevent corneal irritation and injury.

Temporary relief of otalgia may be achieved by applying a local anesthetic or cocaine to the trigger point, if in the external auditory canal.

Carbamazepine may be helpful, especially in cases of idiopathic geniculate neuralgia.

Next

Consultations

Consultation with an infectious disease specialist is recommended.

If a structural lesion is discovered on imaging, consultation with a neurosurgeon or otolaryngologist is recommended.

Consultation with an ophthalmologist to assist with eye care, especially pertaining to the cornea, may be appropriate.

Previous
 
 
Contributor Information and Disclosures
Author

Augusto A Miravalle, MD Fellow, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School

Augusto A Miravalle, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, Drmed, MA, MS Director, National MS Society Multiple Sclerosis Center; Professor and Director, Clinical Research Unit, Department of Neurology, Adjunct Professor of Physical Therapy, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, Drmed, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MD, DM Associate Professor of Neurology, University of Missouri-Columbia School of Medicine

Niranjan N Singh, MD, DM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Acknowledgements

Deepak Awasthi, MD Clinical Professor, Department of Neurosurgery, Louisiana State University School of Medicine; Consulting Staff, Louisiana Brain and Spine Clinic

Deepak Awasthi is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa

Disclosure: Nothing to disclose.

Augusto A Miravalle, MD Fellow, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School

Augusto A Miravalle, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Marion Priscilla Short, MD Assistant Professor, Departments of Neurology, Pediatrics, and Pathology, University of Chicago Hospitals and Clinics

Marion Priscilla Short, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuropathologists, American College of Medical Genetics, American Medical Association, and American Society of Human Genetics

Disclosure: Nothing to disclose.

References
  1. Bhupal HK. Ramsay Hunt syndrome presenting in primary care. Practitioner. 2010 Mar. 254(1727):33-5, 3. [Medline].

  2. Goldani LZ, Ferreira da Silva LF, Dora JM. Ramsay Hunt syndrome in patients infected with human immunodeficiency virus. Clin Exp Dermatol. 2009 Jun 1. [Medline].

  3. Kleinschmidt-DeMasters BK, Gilden DH. The expanding spectrum of herpesvirus infections of the nervous system. Brain Pathol. 2001 Oct. 11(4):440-51. [Medline].

  4. Sandoval C C, Nunez F A, Lizama C M, Margarit S C, Abarca V K, Escobar H R. [Ramsay Hunt syndrome in children: four cases and review]. Rev Chilena Infectol. 2008 Dec. 25(6):458-64. [Medline].

  5. [Guideline] Gilchrist JM. Seventh cranial neuropathy. Semin Neurol. 2009 Feb. 29(1):5-13. [Medline].

  6. Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. 2011 Nov 8. [Medline].

  7. Coffin SE, Hodinka RL. Utility of direct immunofluorescence and virus culture for detection of varicella-zoster virus in skin lesions. J Clin Microbiol. 1995 Oct. 33(10):2792-5. [Medline]. [Full Text].

  8. Naganawa S, Nakashima T. Cutting edge of inner ear MRI. Acta Otolaryngol Suppl. 2009 Feb. 15-21. [Medline].

  9. Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008 Oct 8. CD006851. [Medline].

  10. Dworkin RH, Barbano RL, Tyring SK, et al. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain. 2009 Apr. 142(3):209-17. [Medline].

  11. Aizawa H, Ohtani F, Furuta Y, et al. Variable patterns of varicella-zoster virus reactivation in Ramsay Hunt syndrome. J Med Virol. 2004 Oct. 74(2):355-60. [Medline].

  12. Aviel A, Marshak G. Ramsay Hunt syndrome: a cranial polyneuropathy. Am J Otolaryngol. 1982 Jan-Feb. 3(1):61-6. [Medline].

  13. Byl FM, Adour KK. Auditory symptoms associated with herpes zoster or idiopathic facial paralysis. Laryngoscope. 1976. 86:372-9.

  14. Furuta Y, Aizawa H, Ohtani F, et al. Varicella-zoster virus DNA level and facial paralysis in Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol. 2004 Sep. 113(9):700-5. [Medline].

  15. Furuta Y, Ohtani F, Kawabata H, et al. High prevalence of varicella-zoster virus reactivation in herpes simplex virus-seronegative patients with acute peripheral facial palsy. Clin Infect Dis. 2000 Mar. 30(3):529-33. [Medline].

  16. Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002 Aug 1. 347(5):340-6. [Medline].

  17. Hunt JR. On herpetic inflammations of the geniculate ganglion: a new syndrome of its complications. J Nerv Ment Dis. 1907. 34:73-96.

  18. Kohler A, Chofflon M, Sztajzel R, Magistris MR. Cerebrospinal fluid in acute peripheral facial palsy. J Neurol. 1999 Mar. 246(3):165-9. [Medline].

  19. McKenna MJ, Rauch SD. Practical neurotology. The Practice of Neurosurgery. 1996. Vol: 199.

  20. Pitkaranta A, Piiparinen H, Mannonen L, Vesaluoma M, Vaheri A. Detection of human herpesvirus 6 and varicella-zoster virus in tear fluid of patients with Bell''s palsy by PCR. J Clin Microbiol. 2000 Jul. 38(7):2753-5. [Medline]. [Full Text].

  21. Robillard RB, Hilsinger RL, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg. 1986 Oct. 95(3 Pt 1):292-7. [Medline].

  22. Whitley RJ. A 70-year-old woman with shingles: review of herpes zoster. JAMA. 2009 Jul 1. 302(1):73-80. [Medline].

Previous
Next
 
Herpes zoster oticus, day 6. Image courtesy of Manolette Roque, MD, ROQUE Eye Clinic.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.