Approach Considerations
Treatment goals of Ramsay Hunt syndrome are to minimize disability and relieve symptoms. Clinical evidence shows that earlier start of treatment is correlated with better outcomes. [10]
Medical Care
Oral 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. [23]
Evidence from clnical studies indicates that starting treatment in the first week is correlated with the highest rate of improvement, although treatment started later still has some benefit. [10]
Intravenous high-dose methylprednisolone is not commonly used in the treatment of Ramsay Hunt syndrome, however, it may provide some clinical benefit even if administered late. [24]
Another study concluded that controlled-release oxycodone was safe and generally well tolerated in patients experiencing acute pain due to herpes zoster. [25]
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.
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.
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Herpes zoster oticus, day 6. Image courtesy of Manolette Roque, MD, ROQUE Eye Clinic.
