Abstract
PurposeTo determine the long-term facial palsy outcome of Ramsay Hunt Syndrome by face-to-face grading by House–Brackmann Grading System, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System concomitantly. To compare the applicability of the grading scales. To compare patients’ self-assessed facial palsy outcome results to gradings performed by the investigator. To compare the face-to-face assessed facial palsy outcome to the initial palsy grade.MethodsFifty-seven patients self-assessed their facial palsy outcome and came to a one-time follow-up visit. The palsy outcome was graded by one investigator using the three above-mentioned grading systems concomitantly. The median time from syndrome onset to follow-up visit was 6.6 years.ResultA good long-term face-to-face assessed palsy outcome was enjoyed by 84% of the patients. Trying to assess only one House–Brackmann grade to represent the palsy outcome was impossible for most patients. Facial Nerve Grading System 2.0 worked better, but needed adjustments and certain sequelae findings needed to be neglected for it to be executable. The Sunnybrook system worked the best. Nearly 20% of the patients assessed themselves differently from the investigator: both better and worse.ConclusionThe Sunnybrook scale was the most applicable system used. With antiviral medication, the outcome of facial palsy in Ramsay Hunt syndrome starts to resemble that of Bell’s palsy and emphasizes the importance of recognizing the syndrome and treating it accordingly. The results give hope to patients instead of the gloomy prospects that have stigmatized the syndrome.
Highlights
Ramsay Hunt syndrome (RHS) involves peripheral facial palsy (FP) and herpes blisters in the head and neck area
They were asked to self-assess their RHS FP outcome and were invited to come to one follow-up visit, where their facial function was graded by the corresponding author with House–Brackmann grading scale (HB), Facial Nerve Grading System 2.0 (FNGS), and SB concomitantly
The remaining 108 patients were sent a questionnaire about their RHS and were invited for one follow-up visit for facial function grading
Summary
Ramsay Hunt syndrome (RHS) involves peripheral facial palsy (FP) and herpes blisters in the head and neck area. In addition to the facial nerve (cranial nerve VII), the vestibulocochlear nerve (cranial nerve VIII) is frequently affected, which causes hearing loss, tinnitus, and/or vertigo [1]. Clinicians must be alert to remember the syndrome and inform patients of this possibility. Published studies on RHS FP outcomes are scarce, including mostly retrospective chart studies, and lacking long follow-up periods; few follow the patients even up to 1 year [7, 12, 13]. The only reported prospective study including RHS patients with 1-year follow-up is from prior to when medical treatment was offered to these patients
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