Ramsay Hunt syndrome: clinical presentation and prognostic factors

Objective: Ramsay Hunt Syndrome (RHS) is a peripheral facial nerve palsy (FP) associated with otalgia and vesicular eruptions on the external ear. This study aimed to evaluate the clinical features of RHS and determine the prognostic factors. Materials and methods: This was a retrospective study, which included 52 patients with RHS who underwent combined steroid and antiviral treatment. The House-Brackmann (HB) grading system was used for the initial presentation and final outcome, as follows: full recovery (HB I), satisfactory outcome (HB II), and poor recovery (HB V and VI). The associated clinical symptoms, side of FP, delay of treatment, time of initial facial function improvement, comorbid diseases, time of vesicle eruption, audiogram testing, initial nerve excitability test (NET), and electroneurography (ENoG) were evaluated to identify correlations with the final HB grade. Results: At presentation, more than half (55%) the RHS patients were HB V and VI. Full recovery was achieved in 19 (36.5%) patients, there was a satisfactory outcome in 23 (44.2%), and poor recovery in 2 (3.8%). The most common symptoms were headache of the temporal area (57.6%) and imbalance (44.2%). The initial NET threshold and percentage degeneration on ENoG most significantly correlated with the final HB grade. Conclusions: Headache in the temporal area and imbalance were the most common symptoms of RHS; while, the NET and ENoG were the most important prognostic factors. In the early phase, a lack of response on the NET and an increased percentage of degeneration on ENoG were clinically correlated with poor outcome.