Ramsay Hunt Syndrome

1.

Ramsay Hunt syndrome affects the

A.

External auditory canal
B.

Vestibule of nose
C.

Pyriform fossa
D.

Adenoid

Correct Answer
A. External auditory canal

Explanation
This condition affects the external auditory canal and is associated with the following symptom complexes:
1. Herpetic blisters in the external auditory canal
2. Lower motor neuron facial palsy
3. Otalgia

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2.

Enumerate the features of Ramsay Hunt syndrome

A.

Otalgia
B.

Rashes in the external auditory canal
C.

Lower motor neuron facial palsy on both sides
D.

Ipsilateral Lower motor neuron facial palsy
E.

Perforation in the pars tensa portion of ear drum
F.

Otalgia

Correct Answer(s)
A. Otalgia
B. Rashes in the external auditory canal
D. Ipsilateral Lower motor neuron facial palsy
F. Otalgia

3.

Ramsay Hunt sydrome is caused by _________________ Infection

Correct Answer(s)
Herpes zoster type 3 infection of geniculate ganglion

4.

Name the features seen in this patient

A.

Inability to close right eye
B.

Ptosis of left eye
C.

Deviation of angle of mouth to the right side
D.

Loss of wrinkles over left forehead

Correct Answer
A. Inability to close right eye

Explanation
This patient shows manifestations of right lower motor neuron type of facial palsy. The features include: Inability to close the right eye, deviation of angle to mouth to the left side, loss of wrinkling over right forehead. In upper motor neuron type of facial palsy wrinkling of forehead will be present.

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5.

Discuss the pathophysiology of Herpes zoster oticus.

6.

Enumerate the clinical features of Ramsay Hunt syndrome.

7.

Investigations performed to diagnose Ramsay Hunt syndrome include

A.

Serologic tests for Varicella virus
B.

Pure tone audiometry
C.

Electronystagmography
D.

Facial nerve conduction studies
E.

Video laryngoscopy
F.

Stroboscopy
G.

CSF analysis

Correct Answer(s)
A. Serologic tests for Varicella virus
B. Pure tone audiometry
C. Electronystagmography
D. Facial nerve conduction studies

8.

Management of patients with Ramsay Hunt syndrome include

A.

Pain killers
B.

Corticosteroids
C.

Acyclovir
D.

Eye care
E.

Nystatin
F.

Grommet insertion

Correct Answer(s)
A. Pain killers
B. Corticosteroids
C. Acyclovir
D. Eye care

Explanation
1. Steps towards alleviating pain: Carbamazepine can be prescribed in doses of 400 mg / day in divided doses. Temporary relief of Otalgia in geniculate neuralgia may be achieved by applying a local anesthetic or cocaine to the trigger point, if in the external auditory canal.

2. Corticosteroids and oral acyclovir can be administered. Steroids in the form of prednisolone can be administered orally in doses of 10mg twice a day. Steroids should not be stopped abruptly. The dosage needs to be tapered. Acyclovir can be administered in doses of 800 mg orally 5 times a day.

3. Management of vertigo: can be managed using meclizine in doses of 25 mg orally 4 times a day.

4. Care must be taken to prevent exposure keratitis because of the inability to close the eye lids. The patients must wear protective goggles.

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