Dr Kamala Kannan from Avadi has posted this article in IMA CGP WhatsApp journal with comments from Dr. Sridhar:

45 yrs old male with earache,deafness and vescicles over rt ear associated with rt sided facial palsy.

Ramsay Hunt Syndrome or Herpes otiticus
it is the herpes zoster infection of ear pinna and external auditory canal
5th and 8th cranial nerves may involved with this

Treat the pain as neuropathic
always r/o any immunocompromising conditions
famciclovir may be a better alternative for acyclovir

Sridhar B. Dr: Vesicles and crust over the Conchae,deafness and Ipsilateral Facial nerve falsy its likely to be RAMSAY HUNT SYNDROME...Its due to reactivation of VZV ie Herpes Zoster of Geniculate ganglion of facial nerve...Prognosis of this condition is relatively poor as COMPARED to Bells palsy.

Rx- Antiviral(Acyclovir or Valacyclovir)
Steroids(Oral)
Care of the eye
Physiotherapy

Sridhar B. Dr: Three different neurological syndromes carry the name of Ramsay Hunt syndrome. Their only connection is that they were all first described by the famous neurologist James Ramsay Hunt (1872–1937).

Ramsay Hunt syndrome type 1, also called Ramsay Hunt cerebellar syndrome, is a rare form of cerebellar degeneration which involves myoclonic epilepsy, progressive ataxia, tremor, and a dementing process.

Ramsay Hunt syndrome type 2 is the reactivation of herpes zoster in the geniculate ganglion. It is sometimes called herpes zoster oticus, and has variable presentation which may include a lower motor neuron lesion of the facial nerve, deafness, vertigo, and pain. A triad of ipsilateral facial paralysis, ear pain, and vesicles on the face, on the ear, or in the ear is the typical presentation.

Ramsay Hunt syndrome type 3 is a less commonly referenced condition, an occupationally induced neuropathy of the deep palmar branch of the ulnar nerve. It is also called Hunt's disease or Artisan's palsy.[4]

Hi Badri
Thanks for posting this topic which is very illuminating. My special thanks are to Dr Kamala Kannan and Dr Sridhar for such a lucid and clear presentation of this rare syndrome in a nutshell.
It used to be a regular topic in postgraduate classes. We don't often come across this syndrome in our regular practice though Herpes Zoster is a very common condition in other areas. We are duped many types by the pre-herpetic pains in different parts and many times this pre-herpetic pains occurring in the head, chest and abdomen has necessitated costly investigations and treatments. Only when the rashes occur on the third or fourth day we realise our pitfall. it used to be said that due to this pre-herpetic pain over abdomen patients had undergone laparotomy too mistaking it as an acute appendicitis. In such suspicious situations you cannot wait for rashes to occur and face complications of an acute abdomen.

UA Mohammed

Hi Mohammed,

I was interested in the condition as one of our classmates now living in South Africa was affected by it. I am sure you know who it is. It was educational and interesting to read this article. I did not realise that there were 3 types until now. Irrespective of our age we learn new things all the time.

Though all these types of neurological syndromes are named after Ramsay Hunt syndromes in 3 types, the one connected with Herpes Zoster is the type 2 only. The other two are entirely different etio-pathological nature. Dr Sridhar has clearly stated that the only connection is that the same person described all the three different neurological syndromes. During postgraduate classes when Ramsay Hunt syndrome was mentioned it used to be only about the type I of which Dr KR was very fond of.
UA Mohammed.

PS: as you mentioned, age cannot be a bar for updating. But persons in the teaching side are forced to be so. In our case it is only out of interest in the subject. Of course so many diversions are main hurdles. I must admit TNMGC is a stimulant.

UAM.