Al-Ani Raid M
Department of Surgery, Otolaryngology, College of Medicine, University of Anbar, Ramadi, IRQ.
Cureus. 2022 Jul 29;14(7):e27434. doi: 10.7759/cureus.27434. eCollection 2022 Jul.
Herpes zoster oticus is a viral disease caused by the reactivation of the varicella-zoster virus at the geniculate ganglion. The hallmark of the condition is multiple unilateral erythematous vesicles, which are distributed over the auricle and preceded by severe otalgia. If these symptoms are associated with facial nerve palsy, the condition is called Ramsay Hunt syndrome (RHS) which is usually accompanied by vestibulocochlear abnormalities. A 42-year-old woman came to our clinic with sudden onset of right-sided severe otalgia and several erythematous vesicles on the auricle two days ago. She provided a history of dysphagia and hoarseness for 10 days. After two days, ipsilateral facial nerve paralysis was noted. The patient was immunocompetent with an unremarkable medical history. Physical examination revealed the following: the vesicles distributed over the right auricle, external auditory canal, and eardrum; right sensorineural deafness; deviated uvula to the left side; absent gag reflex on the right side; right vocal cord palsy; and lower motor facial nerve paralysis of House-Brackmann grade III. The pure tone audiogram confirmed the diagnosis of right-sided sensorineural deafness. Acyclovir therapy and prednisolone tablets at a loading dose were initiated. At the four-month follow-up, the presenting manifestations were improved. Here, we report a case of RHS with early glossopharyngeal and vagus nerve palsy, followed by pain, vesicular eruptions, sensorineural hearing loss, and delayed onset of facial nerve paralysis. The condition resolved completely on medical treatment with acyclovir and prednisolone.
耳带状疱疹是由膝状神经节内水痘-带状疱疹病毒再激活引起的一种病毒性疾病。该病的特征是多个单侧红斑水疱，分布于耳廓，且之前伴有严重耳痛。如果这些症状伴有面神经麻痹，则称为拉姆齐·亨特综合征（RHS），通常还伴有前庭蜗神经异常。一名42岁女性两天前因突发右侧严重耳痛和耳廓上出现几个红斑水疱前来我院就诊。她有10天的吞咽困难和声音嘶哑病史。两天后，发现同侧面神经麻痹。该患者免疫功能正常，病史无异常。体格检查发现：水疱分布于右耳廓、外耳道和鼓膜；右感音神经性耳聋；悬雍垂偏向左侧；右侧咽反射消失；右侧声带麻痹；以及House-Brackmann III级的下运动神经元性面神经麻痹。纯音听力图证实了右侧感音神经性耳聋的诊断。开始使用阿昔洛韦治疗并给予负荷剂量的泼尼松龙片。在4个月的随访中，目前的症状有所改善。在此，我们报告一例伴有早期舌咽神经和迷走神经麻痹的RHS病例，随后出现疼痛、水疱疹、感音神经性听力损失以及延迟出现的面神经麻痹。经阿昔洛韦和泼尼松龙药物治疗后病情完全缓解。
