Ramsay Hunt syndrome management: A multimodal approach

Abstract

Herpes zoster oticus or geniculate neuralgia or nervus intermediate neuralgia, also known as Ramsay Hunt syndrome (RHS), is a rare complication of herpes zoster, which is due to reactivation of latent varicella-zoster virus infection in the geniculate ganglion. RHS causes otalgia, auricular vesicles, and peripheral facial paralysis, rare in children but occurs with a female prediction in adults. Incidence and clinical severity increase with compromised immunity and progressing age. We often stare at a diagnostic challenge as these symptoms do not always present at the onset. Herpes zoster oticus accounts for about 12% of facial palsy cases, which is complete and typically unilateral, and full recovery occurs in only around 20% of untreated patients. With these features, we report the case of a 55-year-old male diagnosed with RHS, which was treated effectively with the combination therapy of antivirals and steroids along with physiotherapy. This article has described various etiopathogenesis, differential diagnosis, and various multimodal treatments available for RHS, including the medical management for immunocompromised patients and available vaccines pre- and postexposure to ensure the better prognosis and complete recovery.