Multifaceted rehabilitation strategies for ramsay hunt syndrome: a case report and a review of literature

Abstract

Background: Ramsay Hunt Syndrome (RHS) is a scarce diagnosis involving unilateral facial paralysis resulting from the reactivation of Varicella-Zoster Virus (VZV) infection in the past, which causes pain, asymmetrical facial expressions, and difficulty in speaking, eating and drinking. The most effective treatment is still debatable, and limited research is available. Rehabilitation program is considered as the core treatment that gives functional improvement. The aim of this case study is to present clinical findings in RHS and the rehabilitation program to maximize facial expression recovery.Case Description: A 59-year-old man came to rehabilitation medicine outpatient clinic two weeks after diagnosed as RHS, with complaints of fever; severe pain and rashes on the left side of the face; and ear discomfort on the same side. Physical examination revealed peripheral facial nerve palsy on the left side with drooping of the left eyelid, left end of the mouth, and difficulty in oral communication. Electroneuromyography (ENMG) examination showed axonal facial nerve paralysis on the left side. The patient was referred to the physiatrist and got rehabilitation program with neuromuscular electrical stimulation (NMES), facial massage and biofeedback exercise for facial muscle 3 times a week for 4 weeks.Discussion: After 4 weeks rehabilitation program, the patient showed improvement as House-Brackmann grades improved from a grade IV to a grade II; improvements in communication, facial symmetry at both rest and motion; significant improvement in experiencing pain. Conclusions: This study suggested that rehabilitation program with NMES, facial massage and biofeedback exercise are safe, efficacious and provide good outcomes in the treatment of Ramsay Hunt Syndrome.