Published: 2016-12-29

A case of herpes zoster oticus with multiple cranial nerve palsy

Debananda Sahoo, Shubhransu Patro, Pankaj K. Khora, Udaya N. Panda


Herpes zoster oticus (HZO) otherwise called as Ramsay Hunt syndrome is a rare complication due to reactivation of the herpes zoster virus in the geniculate ganglion of facial nerve presenting with vesicular eruptions over external ear along with severe otalgia and LMN type of 7th cranial nerve palsy. This syndrome often misdiagnosed because of absence of these symptoms. About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX and X are the ones most commonly affected. Here, we present a case of Ramsay Hunt syndrome with cranial polyneuropathy. The patient was treated with antiviral and oral steroid and the symptoms were improved.


Ramsay Hunt syndrome, Geniculate ganglion, Varicella zoster virus, Otalgia, Acyclovir

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Steiner I, Kennedy PG. Herpes simplex virus latent infection in the nervous system. J Neurovirol 1995;1(1):19-29.

Chitose SI, Umeno H, Hamakawa S, Nakashima T, Shoji H. Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings. J Laryngol Otol. 2008;122(2):170-6.

Nishizaki K, Onoda K, Akagi H, Yuen K, Ogawa T, Masuda Y. Laryngeal zoster with unilateral laryngeal paralysis. ORL J Otorhinolaryngol Relat Spec. 1997;59(4):235-7.

Bossche VDP, Bossche VDK, Vanpoucke H. Laryngeal zoster with multiple cranial nerve palsies. Eur Arch Otorhinolaryngol. 2008;265(3):365-7.

Watelet JB, Evrard AS, Lawson G, Bonte K, Remacle M, Van Cauwenberge P, et al. Herpes zoster laryngitis: case report and serological profile. Eur Arch Otorhinolaryngol. 2007;264(5):505-7.

Kim YH, Chang MY, Jung HH, Park YS, Lee SH, Lee JH, et al. Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy. Laryngoscope. 2010;120:2270-6.

Patro S, Mishra GC, Toppo L,khatua P.Ramsay Hunt Syndrome with 8th cranial nerve palsy in a diabetic patient. Orissa Physicians Journal. 2010;6:98-102.

Korzec K, Sobol SM, Kubal W, Mester SJ, Winzelberg G, May M. Gadolinium-enhanced magnetic resonance imaging of the facial nerve in herpes zoster oticus and Bell’s palsy: clinical implications. Am J Otol. 1991;12:163-8.

Engström M, Abdsaleh S, Ahlström H, Johansson L, Stålberg E, Jonsson L. Serial gadolinium-enhanced magnetic resonance imaging and assessment of facial nerve function in Bell’s palsy. Otolaryngol Head Neck Surg. 1997;117:559-66.

Ohashi T, Fusimoto M, Shimizu H, Atsumi T. A case of isolated vagus nerve palsy with herpes zoster. Rhinso Shinkeigaku. 1994;34:928-9.