Herpes Zoster Oticus With Facial Palsy and Hearing Loss: A Case Report of Ramsay Hunt Syndrome in an Older Patient.

Ramsay Hunt syndrome (RHS) is a rare complication of varicella-zoster virus (VZV) reactivation, typically presenting with a combination of painful vesicular lesions in the ear, facial nerve palsy, and hearing loss. Early diagnosis and antiviral therapy are critical in minimizing long-term sequelae, such as persistent facial weakness and hearing impairment. This case highlights the importance of prompt recognition and treatment in older patients, particularly those with pre-existing hearing difficulties. An 87-year-old female presented with a 2-week history of painful, blister-like lesions on the right ear and lips, associated with a burning sensation. Over several days, the lesions progressed to visible wounds. The patient also reported increasing weakness, difficulty eating, and worsening hearing impairment. Physical examination revealed vesicular lesions on the right pinna and lips, along with right-sided facial weakness (House-Brackmann Grade IV) and slight ipsilateral lagophthalmos with mild conjunctival erythema. No new vesicles or generalized rash were observed. The patient's medical history included hypertension and long-standing bilateral hearing difficulty. Ramsay Hunt syndrome was diagnosed based on the characteristic symptoms of painful vesicular lesions, facial nerve palsy, and hearing loss. The patient was treated with oral acyclovir, dexamethasone, and supportive care. Significant improvement was noted by Day 7, with reduced pain, partial recovery of facial function, and improvement in hearing. By Day 14, all lesions had healed, and facial symmetry was restored. This case emphasizes the importance of early recognition and intervention in improving clinical outcomes in older patients with RHS.