Hunt Syndrome Research Articles

ハント症候群の聴力障害について

ハント症候群の聴力障害について

Acute profound deafness in Ramsay Hunt's syndrome Report of two cases

Acute profound deafness in Ramsay Hunt's syndrome Report of two cases

Neurotological findings in Bell's palsy and Hunt's syndrome.

Neurotological findings were analysed in 23 patients with Bell's palsy and in 25 patients with Hunt's syndrome. The incidence and extent of the auditory and vestibular pathology was high in Hunt's syndrome. Although patients had no subjective symptoms related to the auditory and/or vestibular pathology in the Bell's palsy cases, about one-third of the patients showed abnormal findings upon neurotological examination. Differentiating these two diseases is therefore considered difficult by means of neurotological examination in the same way as by serological testing as has been reported by other investigators.

An ELISA study on varicella-zoster virus infection in acute peripheral facial palsy.

ELISA was applied to atraumatic acute peripheral facial palsy for the purpose of examining the usefulness of the method with respect to early diagnosis of varicella-zoster virus (VZV) infection. The material for this study consisted of 287 cases of Bell's palsy, 64 cases of Hunt's syndrome and 12 cases of zoster sine herpete diagnosed by the CF method, obtained from 16 institutions throughout Japan. In view of the results thus obtained, it was provided that cases of specific anti-VZV-IgG antibodies (anti-VZV-IgG) with a titre of 0.6 or more or specific anti-VZV-IgM antibodies (anti-VZV-IgM) with a titre of 0.2 or more were to be regarded as cases of VZV infection. By adopting ELISA, a diagnostic ratio of 94.3% in Hunt's syndrome was achieved. Moreover, possible cases of zoster sine herpete increased further by 28. Furthermore, most of the cases became diagnosable in the second week after onset of the facial palsy. It was therefore presumed that ELISA makes possible diagnosis in the comparatively early stages with only one testing, and that it is a more useful method than CF.

顔面神経麻ひの統計的観察 近畿大学医学部耳鼻咽喉科における１０年間の統計

A statistical analysis was performed on 342 patients with facial nerve palsy treated at our clinic between May, 1970 and April, 1980. The incidence of Bell's palsy was 71% (242 patients)and that of Hunt's syndrome 16%. Little difference was detected in the initial palsy scores between Bell's palsy and Hunt's syndrome, but significant differences were after a period of two months. Final recovery was significantly better in those with Bell's palsy. In addition, those receiving early treatment showed better final recovery. Better recovery was obtained in Bell's palsy patients under 40 years of age than in those 40 years or more.

多発性脳神経障害を呈したＨｕｎｔ症候群の一例 免疫・ウイルス学的検討

A patient with Hunt's syndrome had not only facial and vestibular nerve paralysis, but also glossopharyngeal, vagal and hypoglossal nerve paralysis. The patient was a 74-year-old fbmale who complained of right auricular pain, vertigo, hoarseness and right facial palsy. Physical examination revealed right auricular herpetic vesicles, peripheral facial palsy, paralysis of the soft palate, right laryngeal paralysis and deviation of the tongue. Hearing was also impaired. Vestibular examination showed right CP and left DP. A varicella-zoster virus(VZV)skin test reflecting cellmediated immunity was negative; a PPD skin test was positive. T and NK cells were decreased. VZV-antibody titers was remarkably high. These laboratory examination showed that humoral immunity was relatively normal but cellmediated immunity was depressed in Hunt's syndrome.

Viral infections in acute peripheral facial paralysis. Nationwide analysis centering on CF.

The degree of participation and regional specificity of virus infection in relation to atraumatic acute peripheral facial palsy was studied, placing particular emphasis on change in the CF titre of varicella zoster virus (VZV), herpes simplex virus (HSV) and adenovirus (adeno). The subjects of the study were 91 patients with Hunt's syndrome and 396 patients with Bell's palsy treated at 17 institutions all over Japan in the period between April 1985 and November 1986. Among the cases of Hunt's syndrome, the positive conversion rate of CF antibody titre of VZV was 81%. In Bell's palsy cases, virus participation was detectable in 8% with VZV, 4% with HSV and 4% with adeno. With regard to the age distribution, Bell's palsy cases with possible virus involvement tended to be observed in younger patients than those without that possibility. As to regional specificity, the incidence of Bell's palsy with possible virus involvement tended to be higher in densely populated areas. With regard to the main cause of acute peripheral facial palsy, virus infection has been implicated, as well as insufficient blood circulation (ischemia). Even in cases of acute peripheral facial palsy, in which herpes zoster oticus is not observed, the participation of varicella zoster virus (VZV) as a cause of paralysis has been pointed out in some cases (zoster sine herpete). Furthermore, it is known that the serum antibody titres of various viruses such as herpes simplex virus (HSV) change significantly in some cases of Bell's palsy (2, 5-13).(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic Value of Blink Test in Patients with Facial Paralysis

In order to gain an early estimate of a prognosis for facial paralysis, the vertical eye movements associated with eyeblinks (Bell's phenomenon) in 39 patients with acute unilateral Bell's paralysis and Hunt's syndrome and of 21 normal subjects were recorded by electronystagmography. These data were then analysed with a small digital computer (PDP 11/34). The results were compared with electroneurography (ENoG) and nerve excitability test (NET) results and can be summarized as follows: 1. Difference in velocity and amplitude between left and right eye movement during eyeblink (called blink index), diminished in inverse proportion to any improvement of lagophthalmos. 2. All the 5 patients showing more than 80% in maximum blink index (MBI) proved to have a poor prognosis, whereas 18 of 19 patients having a MBI of 40% or less proved to have a good prognosis. The blink test was deemed to be of equal clinical significance to ENoG and NET for predicting facial paralysis. 3. The blink test does not require needle electrodes for electrical stimulus, nor any special equipment other than electronystagmography, and yet this test can provide a quantitative analysis of a degeneration profile in facial paralysis.

Nerve excitability test using fine needle electrodes.

The NET using needle electrodes is a simple and useful test. Children readily tolerate the procedure. For prognosticative purposes it is more effective than the conventional NET using surface electrodes. When positive responses to NET using needle electrodes are recorded after 3 days from onset of palsy, irrespective of the absolute threshold value, prognosis is good. In Bell's palsy, NET is positive for 90%, and for 73% in Hunt's syndrome. Apart from one case our patients showed complete recovery by EMG evaluation.

Ｎｉｃｅｒｉｔｒｏｌを用いた顔面神経麻ひの治療成績

Niceritrol, a derivative of nicotinic acid, has been used in the treatment of atherosclerotic and obstructive vascular diseases. It was given to patients with facial palsy for 8 weeks or morc in combination with massive doses of ATP and/or steroids used during the initial 2 or 3 weeks.1. Assessment by our Paralysis and Secondary Defect Scorc showed that the results could be classified as'good'or better in 37.2% of the patients in 2 weeks, 54.2% in 4 weeks, 60.0% in 6 weeks and 68.5%in 8 weeks.2. It was striking that 3 of 4 patients with Hunt's syndrome recovered completely within 4 wceks and one patient with severe paralysis for 20 years due to surgical trauma showed a fair recovery.These results indicate that the combination of niceritrol and ATP and/or steroids is effective in the therapy of facial palsy.

ハント症候群における聴覚障害について

ハント症候群における聴覚障害について

側頭骨内顔面神経麻ひの誘発筋電図における患側大振幅について

In the very acute phase of Bell's palsy and Ramsay Hunt's syndrome, the amplitudes of evoked electromyograms of the orbicularis oculi and oris muscles not rarely appear to extend beyond the upper limit of normal. This abnormally large amplitude declinedvery sharply, and in the second week of the diseases, the amplitude returned to normal or even decreased below normal in 6 patients, 4 out of the 76 patients with Bell's palsyand 2 of the 16 with Hunt's examined in our clinic. In these 6 patients, there was noevidence of denervation, and the facial palsy continued to be incomplete throughout thecourse of the disease. Thus, the abnormally large amplitude was a sign of favorableprognosis of the facial palsy. The results suggest that the facial nerve becomes transiently hyperexitable after moderate damage of the intratemporal area.

高度聴力障害をきたしたＲａｍｓａｙ Ｈｕｎｔ症候群の一症例

高度聴力障害をきたしたＲａｍｓａｙ Ｈｕｎｔ症候群の一症例

正常及び側頭骨内顔面神経麻ひにおける同側及び反対側顔面神経電気刺激による口輪筋誘発筋電図

We performed contralateral and ipsilateral evoked electromyography (EMG) of the orbicularis oris muscle in 9 normal subjects and 32 patients with facial palsies; 22 with Bell's palsy and 10 with Ramsay Hunt's syndrome. In the normal subjects, the amplitude ratio of the contralateral to the ipsilateral evoked EMG ranged from 1:5 to 1:2. In 15 of the patients with facial palsy, the amplitude ratios exceeded the normal range. The amplitude ratios in the denervated group tended to be larger than those in the nondenervated group. These results suggest that contralateral facial nerve fibers innervating beyond the midline might intensify to assist the function of the affected facial nerve.

Ｈｕｎｔ症候群における抗ウイルス剤の適応と効果

Ｈｕｎｔ症候群における抗ウイルス剤の適応と効果

末しょう性顔面神経障害 不完全治ゆ症例を中心とした検討

Patients with peripheral facial palsy caused by Bell's palsy, Hunt's syndrome, trauma, tumor and otitis media were followed for a minimum of 6 months. Of the total group of 159 cases, complete recovery was achieved in 105 (66.0%) and incomplete recovery in 54 (34.0%). Patients with pathologic synkinesis and/or with incomplete return of function were judged to have had incomplete recovery. Of the 54 incompletely recovered patients, 46 (85.2%) had pathological synkinesis, indicating more severe nerve damage than the third degree of Sunderland. The severity of the palsy at the first visit was closely related to the outcome. Patients with Bell's palsy, which was complete at the initial examinations had a lower recovery rate than those with mild or slight palsy (p<0.005). Of the 24 surgically treated patients, 18 (75.0%) had poor results. Surgically treated patients had a lower rate of recovery than conservatively treated patients (p<0.005). The poor outcome was correetly prognosed in 89.2% of the patients with the results of tear tests, salivary flow tests, salivary pH tests, impedance audiometry tests and the NET. The results of the steroid treated incomplete recovery group were compared with those of the surgically treated incomplete recovery group. No statistically significant difference was noted between the two groups. It was possible that the decompression operations were done after irreversible pathological changes had occurred in the facial nerves. It is noteworthy that in 50% of patients with malignant tumors the severity of the palsy fluctuated.

Statistical Analysis of Inpatient at Aichi Medical University

The authors analysed statistically 2, 514 inpatients treated from 1978 to 1983 in this department. Diseases of the ear predominated as did operations on the ear: tympanoplasty, auriculoplasty for microtia, decompression to the facial nerve for Ramsay Hunt's syndrome, Bell's palsy and traumatic facial palsy.

A Case of Hunt's Syndrome with Jumbling Phenomenon

片側性 Jumbling 現象を呈した22才男性の Hunt 症候群症例を報告した. 耳ヘルペス, 顔面神経麻痺, 内耳神経症状すべて具備した完全型 Hunt 症候群症例であり, 約40病日後に頭部を右から左に回転したときに動揺視が生じ, 片側性 Jumbling 現象を呈した. Hunt 症候群による一側性前庭障害により発症したものと考え, 発症約3ヶ月後に Jumbling 現象は消失した.

Statistical Observations on Clinical Diagnosis in Patients with Bell's Palsy and Ramsay Hunt's Syndrome

The authors present the following criteria for the differentiation of Hunt's syndrome from Bell's palsy.A) Hunt's syndrome is characterized by manifest herpetic eruptions or by a high serum antibody titer against varicella zoster virus.B) Incomplete Hunt's syndrome is defined as evident involvement of other cranial nerves with V11 nerve palsy.C) Bell's palsy is simple facial nerve palsy of unknown etiology.From April 1977 to April 1984, 56 cases of facial nerve palsy were examined within two weeks of onset.There were 19 cases of Hunt's syndrome, 14 of incomplete Hunt's syndrome, 14 of Bell's palsy, and 9 others.The authors emphasize that equilibrium tests must be performed, even if the patient has no vertigo, in order to make a correct diagnosis.

側頭骨内顔面神経麻ひにおける眼輪筋と口輪筋の受傷差に関する研究

A total of 30 patients with intratemporal facial palsies of recent onset, 20 with Bell's palsy and 10 with Ramsay Hunt's syndrome, were the subjects of this investigation. From the orbicularis oculi and the oris muscles of both the healthy and the diseased side, evoked electromyograms and electromyograms were obtained using surface electrodes, and strength-duration curves were derived. Comparative analysis of the data obtained from these examinations revealed no difference in these two muscles of the healthy side. On the diseased side, however, the following results suggested a more pronounced vulnerability of the nerve branch innervating the orbicularis oculi muscle than of that innervating the orbicularis oris muscle. 1) The average amplitudes of the electromyogram and of the evoked electromyogram were significantly smaller in the orbicularis oculi muscle than in the oris muscle. 2) A more marked decline of the averaged amplitude of the electromyogram of the orbicularis oculi muscle was noted in the subjects with denervation proved by the strength-duration curve. 3) The same phenomenon was also apparent in the subjects whose facial paralysis score was low.