A patient with Ramsay Hunt syndrome (herpes zoster oticus) presents with vesicular eruption in the concha, complete LMN facial palsy, and severe ipsilateral otalgia. Compared to Bell's palsy, Ramsay Hunt syndrome generally has:
- A Worse prognosis — only 50–60% achieve full recovery even with treatment ✓
- B Better prognosis for full recovery
- C Equal prognosis with identical treatment
- D No requirement for antiviral therapy
Correct answer: A. Worse prognosis — only 50–60% achieve full recovery even with treatment
Explanation
Ramsay Hunt syndrome is caused by VZV reactivation in the geniculate ganglion, causing inflammation and ischaemia of the facial nerve, often affecting the vestibulocochlear nerve as well. It carries a significantly worse prognosis than Bell's palsy: only 50–60% of patients achieve full recovery compared to >85% in Bell's palsy. This is due to greater nerve destruction by VZV. High-dose acyclovir (or valacyclovir) combined with prednisolone should be started within 72 hours.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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