A 45-year-old patient presents with sudden complete unilateral facial palsy, post-auricular pain, and vesicular eruption over the concha and external auditory meatus. Hearing is reduced on the affected side. The diagnosis is Ramsay Hunt syndrome. Which nerve is the reservoir of viral latency, and what is the expected prognosis compared to Bell's palsy?

• A Trigeminal nerve (Gasserian ganglion) — prognosis similar to Bell's palsy
• B Geniculate ganglion of the facial nerve — prognosis is significantly worse than Bell's palsy; only 50–70% achieve complete recovery compared to >90% in Bell's palsy ✓
• C Vagus nerve dorsal motor nucleus — equivalent recovery rates
• D Greater auricular nerve — excellent prognosis with antiviral therapy alone

Explanation

Ramsay Hunt syndrome (herpes zoster oticus) results from reactivation of varicella zoster virus (VZV) latent in the geniculate ganglion of the facial nerve (CN VII). The classic triad is ipsilateral facial palsy, auricular vesicles (Ramsey Hunt zone — concha, EAC, adjacent pinna), and ipsilateral ear symptoms (otalgia, SNHL, vertigo from concurrent cochlear/vestibular involvement). Prognosis is notably worse than Bell's palsy: complete recovery occurs in only 50–70% of cases. Treatment is combined antiviral (acyclovir/valacyclovir) and oral corticosteroids, ideally within 72 hours of onset.

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.