Ramsay Hunt syndrome and Bell’s palsy


Ramsay Hunt Syndrome or ‘Zoster Oticus’ is a rare, severe complication of varicella zoster virus (VZV) or Herpes Simplex Virus (HSV) reactivation in the geniculate ganglion. The triad of RHS consists of otalgia, vesicles in the auditory canal and ipsilateral facial paralysis. The prognosis should be be worse than Bell’s or idiopathic facial palsy, as only about only 20% of patients with RHS should have a full recovery. Furthermore, the recovery onset would be more delayed in cases of RHS in comparison to patients with Bell’s palsy.
I saw some patients with RHS with clinical history and physical features that were indistinguishable from Bell’s palsy except for the presence of few typical vesicles on the pinna. These patients had full recovery in 6-8 weeks after antiviral and corticoid therapy started within 72 hours from the onset of symptoms. Could Bell’s palsy be a mild variant of RHS sine vesicles? (herpes sine herpete?)


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