Comparative Studies in Bell's Palsy and Ramsay-Hunt's Syndrome in Relation to Virus Infection

Abstract

Viral titer was investigated in 159 cases of 296 Bell's palsy and in 44 cases of 66 Ramsay-Hunt's syndrome. Diagnostic titer of viruses was observed in 55 cases of 159 Bells palsy (35%) including 21 cases of herpes zoster virus (13%). These 21 cases are regarded as ‘Zoster sine herpete (ZSH)’ because they have peripheral facial paralysis with a diagnostic titer of herpes zoster virus but without herpes oticus.Cases of ZSH generally had a lower titer of herpes zoster virus than cases of Ramsay-Hunt's syndrome. Those with ZSH showed a more severe degree of facial paralysis than did those with Bell's palsy and a negative titer of viruses. Furthermore, those with ZSH showed a negative stapedial reflex in 3 cases out of 4 and suggested a more likely possibility of supra-stapedial lesion in ZSH. As for the clinical course, those with ZSH showed a tendency toward a longer period for complete recovery than did any of the others with Bell's palsy, but no definite statistical differences among Ramsay-Hunt's syndrome, ZSH, and Bell's palsy with negative titer of viruses were noted. In addition, those with ZSH revealed intermediate features between those with Ramsay-Hunt's syndrome and Bell's palsy with regard to distribution. There were no particular findings concerning vestibular involvement.