Ramsay Hunt syndrome (herpes zoster oticus) is caused by reactivation of VZV. Which nerve ganglion is primarily affected, and what is the characteristic clinical triad?
- A Trigeminal ganglion; trigeminal neuralgia + facial palsy + vesicles on tongue
- B Superior cervical ganglion; Horner's syndrome + otalgia + vesicles on neck
- C Geniculate ganglion of the facial nerve; LMN facial palsy + herpetic vesicles in the ear/oropharynx + otalgia ✓
- D Glossopharyngeal ganglion; palatal palsy + pharyngeal vesicles + LMN facial palsy
Correct answer: C. Geniculate ganglion of the facial nerve; LMN facial palsy + herpetic vesicles in the ear/oropharynx + otalgia
Explanation
Ramsay Hunt syndrome results from VZV reactivation in the geniculate ganglion of the facial nerve. The classic triad is: (1) LMN facial nerve palsy, (2) herpetic vesicles on the external ear (pinna, EAC), soft palate, anterior two-thirds of tongue, and (3) severe otalgia. SNHL and vertigo may occur due to involvement of the cochleovestibular nerve. Treatment: acyclovir + prednisolone within 72 hours — prognosis is worse than Bell's palsy (only ~60–70% full recovery).
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.