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In its most common usage, the term Ramsay Hunt syndrome refers to a reactivation of the dormant VZV in the geniculate ganglion with associated unilateral facial paralysis and other known symptoms. It is a complication of shingles, and results in facial paralysis or facial weakness (due to trauma to the 7th cranial nerve) and, usually, lesions of the skin similar to those seen with chickenpox. Other common symptoms are severe pain (on the face, head and in or around the ear), hearing loss, tinnitis and dizziness.

It is classed as a rare ‘disease’ and is believed to be even more rare in children. The immunocompromised and the elderly are more likely to develop RHS and it affects both sexes equally. However, any factor that impairs the immune system can leave a person who harbours the varicella zoster virus vulnerable to Ramsay Hunt syndrome. It is not contagious in the sense that the syndrome itself can be transmitted from one person to another, but a person with no immunity to chickenpox can contract chickenpox by transmission of the virus through contact with open skin lesions.

Ramsay Hunt syndrome is a much more serious illness than Bell’s Palsy (the most common form of facial paralysis) and requires immediate medical attention. Many researchers believe that Bell’s Palsy is caused by the herpes simplex virus type 1, which is not a causative factor of Ramsay Hunt syndrome.

Why is it called Ramsay Hunt Syndrome?

Ramsay Hunt syndrome is named for Dr. James Ramsay Hunt

Dr. James Ramsay Hunt (1872 - 1937)

Dr. James Ramsay Hunt (1872 – 1937)

Born in Philadelphia in 1872, Dr James Ramsay Hunt qualified as an MD at the age of 21 at the University of Pennsylvania. He moved to Europe to continue his studies in Paris, Vienna and finally Berlin until returning to America as a neurologist at Cornell University Medical School from 1900-1910.

In 1907, he observed a number of curious conditions which presented with facial paralysis plus classic 8th nerve symptoms including otalgia, hearing loss, tinnitus, vesicular rash (pinna and ear canal), vertigo, dizziness, loss of balance, vomiting, and nystagmus. He proposed that this previously unrecognised illness was caused by an infection of the geniculate ganglion which runs in close proximity to the vestibulocochlear nerve along the narrow facial canal.

His published analysis of clinical variations of the syndrome led to it being identified by his name.

Besides his work as a consultant he carried out major research on the anatomy and disorders of the corpus striatum and the extra-pyramidal system.

He was on the faculty of the College of Physicians and Surgeons of Columbia University in 1911-13 and again from 1924 onwards. He was Consulting Neurologist and Senior Attending Neurologist at the Neurological Institute of New York from c.1914 to 1937.

Please note that Dr Ramsay Hunt lent his name to at least three unconnected conditions.

Cause

The varicella-zoster virus is the cause of Ramsay Hunt syndrome II. It can lie dormant in the body for decades after its first incarnation as chickenpox. A recurrence of the virus is shingles and one complication of shingles is Ramsay Hunt syndrome.

The Varicella Zoster Virus

The Varicella Zoster Virus

The varicella-zoster virus infection may lead to inflammation or damage to the seventh cranial nerve (facial nerve carrying about 7,000 ‘fibres’ which control the facial muscles) over a number of days. Responses to the inflammation can include any or all of the following: the onset of paralysis of one side of the subject’s face, ear or facial pain on one side, loss of the sense of taste on one side of the tongue, dizziness, and one-sided hearing loss or tinnitus. Although initial symptoms seem to be quite dramatic many patients may experience a full and complete recovery. The chances of a good recovery are currently thought to be about 70%.

People who have had chickenpox (varicella zoster) in their youth can develop shingles (herpes zoster) in later years. During an acute attack of the chickenpox virus, most of the viral organisms are destroyed, but some survive, travel up nerve fibers along the spine, and lodge in nerve cells where they may lie dormant for many years.

A Course  Of Shingles

A Course  Of Shingles

A decrease in the body’s resistance can cause the virus to reawaken decades later. It then travels back down the nerve fibers to the skin’s surface.

The reawakened virus generally causes a vague burning sensation or tingling over an area of skin. A painful rash usually occurs two to five days after the first symptoms appear. A cluster of small bumps (1) turns into blisters (2) that resemble chicken pox lesions. The blisters fill with pus, break open (3), crust over (4), and finally disappear. This process takes four to five weeks.

Symptoms

The symptoms of Ramsay Hunt Syndrome vary from case to case and may, but not always, include:

Unilateral Facial Paralysis

 

  • A ‘drooping’ of the face on the affected side.
  • An inability to close the affected eye, smile, wrinkle the forehead and whistle.
  • Tearing or dryness occurs because the eye does not close completely.
  • Speech may be mildly slurred.

 

It is important to note that sensory function (feeling) is unaffected by RHS facial paralysis; only motor function (movement) is affected. For example, an ice cube should still feel cold when held against the affected side. If sensory function is affected please notify your doctor immediately.

Speech Impairment

Speech may be mildly slurred.

Unilateral neuralgia

Severe pain on the affected side around the head, ear, or neck.

Increased / Decreased Lacrimation

Tearing or dryness can occur because the eye does not close completely.

Unilateral Dysgeusia

Loss of taste on the anterior 2/3 of the tongue or unusual tastes, such as metallic or salty.

Xerostomia

Dryness in the mouth.

Hyperacusis

Sounds may appear louder on the affected side. This may be caused by paralysis of the stapedius muscle but also occurs independently.

Papillitis

Inflammation of the fungifom papillae at the back of the tongue may be seen on the affected side.

Shingles Vesicles / Rash

A painful herpes type skin eruptionin the ear canal or on the pinna of the ear. Also may appear as small, painful blisters in the mouth or throat.

Hearing loss

Hearing loss or distortion on the affected side.

Tinnitis

Noises in the affected ear.

Vertigo

Room spinning dizziness.

Disequilibrium

Dizziness when standing or walking. Inability to walk a straight line.

Complications / Side Effects

  • Depression

    Clinical depression is a state of intense despair or sadness that has become disruptive to the patient’s daily life. Non-clinical depression is a feeling of sadness that does not affect the patient’s ability to function. Clinical depression is much more serious than normal depressed feelings; it can even lead to suicidal thoughts and requires immediate medical attention.
  • Post Viral Fatigue

Post-viral fatigue syndrome (PVFS) is a term describing the extended fatigue and weakness common after any severe viral infection. This fatigue is a severe mental and physical exhaustion or depletion which is unrelieved by rest and is often worsened by even trivial exertion.

The term is not widely used, but the state of prolonged or severe fatigue after a viral illness is not uncommon. Some persons will experience fatigue of a few months to years following a severe infection or illness. Some researchers claim that post-viral fatigue results from damage to the immune system, and that it is common to many post-viral patients. In the UK, PVFS was adopted as a new name for Myalgic Encephalomyelitis (ME), while in the United States and elsewhere the syndrome is known as Chronic Fatigue Syndrome.

  • PostHerpetic Neuralgia

Pain following a herpes infection. Pain that persists for longer than a month after the vesicles (blisters) disappear is likely to be PHN. It is more common in patients over 50. PHN may develop as a continuation of pain that accompanies the onset of RHS or it may develop later. The pain usually resolves within 6 months but in about 1% of patients pain will continue for a year or longer.

  • Vestibular Problems

Symptoms of vestibular dysfunction due to RHS include vertigo, often accompanied by nausea, and dysequilibrium. Vertigo refers to an illusion of motion when there is conflicting information going to the brain from the eyes and the inner ear, and is often described as a spinning sensation. Dysequilibrium is often described as a feeling of being lightheaded, woozy, drunk, disoriented, and unsteady when walking. In RHS, vestibular problems usually result from viral injury to the 8th cranial nerve.

  • Vocal Cord Paralysis

Inability of one or both vocal cords (vocal folds) to move. In RHS, the paralysis is due to viral damage to the nerves leading to the vocal cords.

Cranial Nerve Syndrome Complications

  • Cranial Nerve Palsies

Dysfunction of cranial nerves are called cranial nerve palsies. Inflammation of CN VII, the facial nerve, is characteristic of RHS, causing facial muscle paralysis and loss of taste. The second most common CN involved is CN VIII, the vestibulocholear nerve, resulting in loss of hearing, vertigo, disequilibrium, tinnitis, and/or hyperacusis.

Other nerves less commonly affected include: CNs III, IV, and VI, the oculomotor, trochlear, and abducens nerves, respectively, controlling eye movement and focusing and pupil dilation; CN V, the trigeminal nerve, controlling the senses of touch and pain in the face and head as well as the jaw muscles; and CN IX, the Glossopharyngeal Nerve, controlling swallowing and the gag reflex.

  • Granulomatous Angiitis
  • Meningoencephalitis

Inflammation of the brain and spinal cord and their meninges (the system of membranes that envelop the central nervous system). Also called encephalomeningitis. Meningoencephalitis is most likely to be seen in immunocompromised patients.

  • Myelitis

Myelitis is a disease involving swelling of the spinal cord, which disrupts central nervous system functions linking the brain and limbs.

 

Disseminated (Systemic) Zoster

Which may lead to:

  • Encephalitis

Encephalitis is an acute inflammation of the brain. It can lead to brain damage and death as the inflamad brain pushes against the skull. It is a rare complication of RHS.

  • Hepatitis

Hepatitis is inflammation of the liver. It is a rare complication of RHS.

  • Pneumonitis

Pneumonitis is inflammation of lung tissue. As a complication of RHS, this may be a result of paralysis of the muscles that control swallowing, permitting foreign matter to be aspirated into the lungs. It is a rare complication of RHS.

Ear Problems

  • Deafness: A physical condition characterized by lack of sensitivity to sound.
  • Tinnitus: Tinnitus is the medical term for noise that people hear in one ear, both ears or in their head without stimulus from the surroundings. Tinnitus is experienced in many different ways, such as ringing, buzzing, humming, whistling, or music.

Eye Problems

  • Blindness

Blindness is the condition of lacking visual perception due to physiological or psychological factors.

  • Conjunctivitis

Conjunctivitis (aka pinkeye) is an inflammation of the conjunctiva, the mucus membrane covering the inner side of the eyelids and the white of the eyes. It is a fairly common condition and is usually caused by allergies or baterial/viral infections.

  • Corneal ulceration

An ulcer on the cornea of the eye, considered an ophthalmologic emergency because of the danger of scarring and blindness. The ulcers generally follow a trauma (e.g., abrasion) to or severe dryness of the corneal epithelium, providing an entry for bacteria.

  • Glaucoma

Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy.

  • Iridocyclitis

Iridocyclitis, a type of anterior uveitis, is a condition in which the uvea of the eye suffers inflammation.

  • Keratitis

Keratitis is an inflammation of the cornea, the clear membrane which covers the coloured part of the eye (iris) and the pupil. Bacterial/viral infections, abrasions on the cornea and a very dry cornea can lead to keratitis. If left untreated it can cause blindness so immediate medical attention is required.

Other Cranial Nerve Syndromes

Particularly Ophthalmic Zoster.

  • Ophthalmic Zoster.

When the varicella-zoster virus is reactivated in the trigeminal nerve’s ophthalmic division, the infection is called ophthalmic zoster or herpes zoster ophthalmicus. Most frequently, vesicles appear around the orbit of the eye. Complications of ophthalmic zoster may include chronic ocular inflammation, loss of vision, and debilitating pain.

Shingles Vesicles

  • Disseminated Cutaneous Zoster

Disseminated cutaneous zoster has been defined as more than 20 vesicles outside the area of the primary and adjacent dermatomes. This complication of zoster has been described in immunocompromised persons (HIV, cancer, patients on immunosuppressive therapy). However, disseminated cutaneous zoster in otherwise healthy persons who are not on immunosuppressive therapy and have no underlying cancer is rare.

  • Secondary bacterial infection of the vesicles

Secondary infections, including cellulitis, can be caused by the introduction of any one of many bacteria to open lesions at the site of the zoster outbreak. Such bacteria can include Group A streptococcus, which can cause severe infection. Good hygiene can help prevent this complication. Should such secondary bacterial infection occur, early recognition and treatment of the infection is necessary. This is most often seen in immunocompromised patients. However, open, weeping sores in any RHS patient are vulnerable to additional infection

A painful condition called post-herpetic neuralgia can sometimes occur. This condition is thought to be caused by damage to the nerves (5), and can last from weeks to years after the rash disappears.

Diagnosis

Diagnosis of Ramsay Hunt syndrome is often difficult, because of the similarity of its symptoms to other illnesses and because not all patients display the same symptoms in the same order or to the same degree.

Your doctor is likely to use one or more of the following to eliminate other possible causes of your symptoms and to ultimately diagnose Ramsay Hunt syndrome.

Blood Test

Blood tests may confirm the presence of the varicella-zoster virus but they are not usually carried out. One such test is the VZV IgG Antibody Titer.

CT (Computed Tomography) Scan

A non-invasive procedure in which a large series of two dimensional X-ray images of the head and, possibly, the neck are computer processed to produce a three-dimensional image of the affected area. This test can sometimes show inflammation of the nerve, but is more often used to depict bony tissue and to eliminate other possible causes of symptoms.

Eye Test

If the eyelid on the affected side will not fully close, the affected eye is visually examined to check for dryness. If a change in vision is suspected, the patient may be asked to focus on a pen or finger and follow it from side to side and forward and back with only eye movement. The patient may be referred to an ophthalmologist.

Fluorescein Eye Stain

This is a test that uses orange dye (fluorescein) and a blue light to detect damage to the cornea, the outer surface of the eye.

Hearing Test

If hearing loss on the affected side is suspected, hearing may be tested using one or more tuning forks or using audiometry (usually performed in a soundproof booth while wearing earphones).

MRI (Magnetic Resonance Imaging)

A non-invasive procedure using non-ionizing radio frequency signals to produce soft-tissue neuroimages (pictures of the brain). MRI is used to eliminate other possible causes of symptoms, such as a tumor. MRI, when used with an IV injection of a contrast material, also can show inflammation of the facial nerves and determine whether the infection has spread to other nerves or the brain.

Nerve Conduction Test (Electromyography)

Occasionally, a nerve conduction study may be done to determine the extent of damage to the facial nerve and potential for recovery. This test may be performed on the surface of the skin using contact pads or subcutaneously using fine-scale conductive probes.

Nystagmus test

Nystagmus is defined as involuntary movement of the eyes. Head movement, head shaking, caloric testing (warm or cold water or air circulated in the ear canal), and/or tracking a moving object or field may be used to determine the degree of vestibular impairment.

Otoscope Ear Examination

An otoscope may show an inflamed ear canal and lesions in the ear canal and on the pinna of the ear are indicative of the presence of varicella-zoster virus.

Physical Examination

Generally, observation of evidence of facial weakness and a vesicular rash are the sole determining factors for diagnosis.

Spinal Tap (Lumbar Puncture)

A spinal tap is used in rare cases, especially when the diagnosis is not clear. Cerebral spinal fluid is removed from the spinal column, after numbing with local anesthetic, using a spinal needle. The fluid is then tested for evidence of the varicella-zoster virus.

Incidence / Risk Factors

Varicella zoster virus (VZV) reactivation in Ramsay Hunt Syndrome (RHS) and zoster sine herpete (ZSH), is the second most common cause of acute peripheral facial palsy (APFP), after Herpes Simplex Virus (HSV) in Bells palsy.

Ramsay Hunt Syndrome has been classified a rare disease by the Office Of Rare Diseases of the National Institutes of Health (USA) which means that it affects fewer than 200,000 people in the United States (population est. 300 million).

Commonly misdiagnosed

Most doctors will never encounter a case of RHS in their medical careers so widespread knowledge and understanding about the condition is limited.

Misdiagnosis as Bells palsy (BP) is a common hazard which can lead to a patient’s health deteriorating rapidly.

The difficulty in diagnosis lies with current examination standards and the similarities between RHS and BP. Both sets of patients experience a sudden onset of unilateral facial paralysis (less than 48 Hrs) and in early RHS vesicular eruptions may not yet have developed. Zoster sine herpete never presents with vesicles hence this group forms the largest proportion of misdiagnosed patients. Classic RHS symptoms like severe otalgia or vertigo are often ignored by inexperienced doctors, apportioning blame to ‘severe Bells palsy’ or drug side-effects.

Other common misdiagnoses include bacterial ear infection, flu, sinusitis.

Laboratory tests are not routine

To correctly distinguish between RHS/ZSH and BP, laboratory tests could be performed to detect VZV blood samples, tears, vesicular fluid and vesicular skin samples. However, these studies are expensive and not routine.

The discrepancy of these misdiagnoses greatly impact the accuracy of incidence and prevalence statistics for RHS and BP. Furthermore, it implies that there are considerably more RHS patients and considerably less BP patients than previously believed.

Secondary conditions (symptoms, complications) arising from RHS can increase in probability, severity and duration without treatment and potentially fatal complications like viral encephalitis risk being overlooked.

Risks of exposure

As a complication of shingles, Ramsay Hunt Syndrome can only develop in patients who have had chickenpox so if you have never had chickenpox you can not develop RHS.

Chickenpox is a highly contagious disease which spreads easily to those who have not been previously infected. Shingles on the other hand can not be ‘caught’ directly. However, a person without a previous chickenpox infection may catch chickenpox (but never shingles itself) by direct contact with vesicular fluid on an RHS/shingles patient.

Continuing studies suggest that exposure to chickenpox provides natural boosting of immunity against VZV and further suppresses the dormant virus. This is thought to reduce, delay or prevent the onset of shingles.

It is expected that more widespread use of the recently developed vaccines for chickenpox and shingles will further reduce the risk of RHS.

Misdiagnosis

Commonly misdiagnosed

Most doctors will never encounter a case of RHS in their medical careers so widespread knowledge and understanding about the condition is limited.

Misdiagnosis as Bells palsy (BP) is a common hazard which can lead to a patient’s health deteriorating rapidly.

The difficulty in diagnosis lies with current examination standards and the similarities between RHS and BP. Both sets of patients experience a sudden onset of unilateral facial paralysis (less than 48 Hrs) and in early RHS vesicular eruptions may not yet have developed. Zoster sine herpete never presents with vesicles hence this group forms the largest proportion of misdiagnosed patients. Classic RHS symptoms like severe otalgia or vertigo are often ignored by inexperienced doctors, apportioning blame to ‘severe Bells palsy’ or drug side-effects.

Other common misdiagnoses include bacterial ear infection, flu, sinusitis.

Laboratory tests are not routine

To correctly distinguish between RHS/ZSH and BP, laboratory tests could be performed to detect VZV in blood samples, tears, vesicular fluid and vesicular skin samples. However, these studies are expensive and not routine.

The discrepancy of these misdiagnoses greatly impact the accuracy of incidence and prevalence statistics for RHS and BP. Furthermore, it implies that there are considerably more RHS patients and considerably fewer BP patients than previously believed.

Secondary conditions (symptoms, complications) arising from RHS can increase in probability, severity and duration without treatment and potentially fatal complications like viral encephalitis risk being overlooked.

Mortality / Morbidity

Secondary Bacterial Infection

A secondary bacterial infection (most often streptococcal or staphylococcal) of the shingles vesicles may develop.

Weakness of the Facial Nerve

There is a risk of no or only partial recovery of the seventh cranial nerve, resulting in permanent peripheral facial nerve weakness.

Dizziness

When the eighth cranial nerve is involved, there is a risk of no or only partial recovery, resulting in long lasting or permanent disequilibrium or other balance problems.

Deafness and Tinnitus

When the eighth cranial nerve is involved, there is a risk of no or only partial recovery, resulting in loss of hearing and/or tinnitus.

Postherpetic Neuralgia

PHN is frequently seen as a complication following a herpes zoster infection such as RHS. Postherpetic neuralgia is defined as pain that persists for longer than one month following healing of the shingles vesicles. Postherpetic neuralgia may appear to be a continuation of the pain that accompanies the acute phase of the zoster infection or it may appear after the pain accompanying the initial reactivation of the zoster virus has faded. Most frequently, postherpetic neuralgia pain will resolve within 6 months. However, a small number of patients continue to have pain even after a year or more. The incidence of this complication increases with age, being most common in patients older than 50 years.

Diseases of the Eye

When the second branch of the trigeminal nerve is involved in the zoster infection, there is a risk of developing conjunctivitis, corneal ulceration, iridocyclitis, keratitis, glaucoma, or blindness.

Systemic Zoster Infection

The spread of the zoster virus to other parts of the body is more likely to be seen in immunocompromised patients. In such cases, the involvement of multiple areas of the skin may occur as the virus is spread via the blood. Involvement of internal organs can also occur. Such systemic involvement can lead to death due to encephalitis, hepatitis, or pneumonitis.

Meningoencephalitis

Meningoencephalitis resembles both meningitis (an inflammation or infection of the meninges) and encephalitis (an inflammation or infection of the brain). Immunocompromised patients are more likely to develop meningoencephalitis secondary to RHS than are immunocompetent patients.

Other Central Nervous System Complications

These may include granulomatous angiitis (possibly leading to a stroke) and myelitis.

Pathology

Mild injury to the facial nerve causes “neuropraxia”. The nerve is still there, it just is slowed down. There is decreased impulse conduction, and prognosis is good.

Moderate injury may cause interruption of axoplasmic flow and axonotmesis. Wallerian degeneration occurs over 2-3 weeks. Full recovery generally occurs within 2 months.

Severe injury is called “neurotmesis”. Wallerian degeneration occurs over 3-5 days, misdirected axon regeneration occurs and patients experience prolonged recovery and often develop synkinesis.

Fragmentation, swelling and degeneration is often seen in axon cylinders. There may be lymphocytic infiltration of nerve bundles.

Prevention

Chickenpox Vaccine

Chickenpox (also called varicella) is a common childhood disease, and can be contracted also as an adult. After the initial infection, the varicella zoster virus lies dormant in the nervous system. A lowering of one’s immunity can cause reactivation of the virus leading to shingles, of which RHS is a complication.

Chickenpox vaccine can prevent chickenpox. Most people who get chickenpox vaccine will not get chickenpox, thus will not harbor the virus that can later cause RHS.

Shingles Vaccine

Clinical trials have proven that the Zostavax vaccine reduces the risk of shingles, and reduces severity if one does get shingles.

Stress Control

Many studies have shown that stress can weaken the immune system, and that those under significant stress are more likely to suffer from infections than those who are not. For this reason, it is believed that stress can precipitate outbreaks of shingles, and thus RHS could result.

Prognosis

If damage to the nerve is minimal, then a good recovery is usually expected. If damage is more severe, there may not be full recovery even after several months. Overall, chances of recovery are better if treatment is started within 3 days of onset of symptoms. It is very important that the appropriate dosage of medications are issued to assure that the virus becomes dormant. The Physicians Desk Reference ® calls for a significantly stronger dosage of antivirals for the zoster virus that causes RHS than that prescribed for Bell’s Palsy, the most common misdiagnosis.

Children are more likely to have a complete recovery than adults. Older adults are less likely to achieve full recovery than younger adults.

Recovery may be complicated if the nerve grows back to the wrong areas (synkinesis) which may cause inappropriate responses, such as tears when laughing or chewing (croc´s tears). Some may experience involuntary closing of the eye when talking or eating food.

There may also be long term damage in hearing as full recovery only occurs in 50% of patients and residual tinnitus is commonplace.

Vertigo can continue for several months after onset of Ramsay Hunt syndrome but often leaves after only a few weeks. The initial onset of vertigo can produce severe nausea and vomiting in cases but prolonged effects are rare. Somewhat more common is residual disequilibrium due to severe damage to the vestibular nerve.

Relapses / Recurrences

Shingles can be a recurring problem for many sufferers and its frequency is more dangerous for those with weakened immune systems such as HIV or people receiving cancer chemotherapy.

Ramsay Hunt syndrome is not thought to recur although there are some rare cases of recurrent bouts.

Treatment

The key to recovery from Ramsay Hunt syndrome is the prompt and effective treatment of the varicella zoster virus. Anti-viral medications such as Valtrex, Acyclovir, or Famciclovir are recommended for 7 to 10 days along with strong anti-inflammatory steroids (such as Prednisolone/Prednisone) for 3 to 5 days which are tapered off in about a week or more. Although steroids are usually recommended for the treatment of these acute symptoms and complications, new studies question the effectiveness and viability of this course of action. In patients at risk, blood pressure, blood glucose and electrolytes should be monitored throughout the treatment.

Antivirals

In RHS, the antiviral medication inhibits the replication of viral DNA needed to reproduce itself. Virally infected cells absorb more of the antiviral medication than do normal cells and convert more of it to an active form which prolongs its antiviral activity where it is most needed. Appropriate antiviral medication may reduce the severity and duration of RHS if given soon after the onset of symptoms. Examples of antivirals commonly used in the treatment of RHS include Acyclovir (Zovirax), Famciclovir (Famvir), and Valacyclovir (Valtrex).

Corticosteroids

Corticosteroids are often prescribed to reduce inflammation of the facial nerve. Their effectiveness is a matter of contention due to the difficulty of judging how well a patient would have recovered without treatment. This has led to a situation where the decision to prescribe Corticosteroids has been left to the personal opinions of the Doctor and the patient.

Hospitalisation

Hospitalisation is not normally called for in cases of Ramsay Hunt Syndrome. However, certain side effects such as encephalitis may make hospitalisation necessary. Also, if the medical team thinks it advisable to administer antiviral medication intravenously, the patient may be hospitalised.

  • Treatment for Disequilibrium
  • Treatment for Facial Paralysis
  • Treatment for Hyperacusis
  • Treatment for Nausea & Vomiting
  • Treatment for Pain
  • Treatment for Post-Viral Fatigue
  • Treatment for PostHerpetic Itch
  • Treatment for PostHerpetic Neuralgia
  • Treatment for Shingles
  • Treatment for Tinnitus
  • Treatment for Vertigo
  • Treatment for the Eye
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