What is it?

• Reactivation of varicella zoster virus in the geniculate ganglion 
• Major otologic complication of herpes zoster
• Can result in permanent facial weakness/paralysis and deafness: early treatment reduces this risk

How does it present?

• Classic Triad: ipsilateral facial paralysis, ear pain, vesicles in auditory canal and auricle 
• Facial paralysis results from CN7 involvement, however can also involve CN8 (tinnitus, hearing loss, nausea, vertigo)
• Ear pain usually precedes rash by hours to days
• Other: fever, cervical adenopathy, headache, gait ataxia

So what do I do about it?

• Tx: Antivirals (acyclovir, valacyclovir, or famciclovir), prednisone, analgesics 
• Cornea eye protection w/ CN7 paralysis (artificial tears, ophthalmic ointment, etc.)
• Poor Prognostic Indicators: age > 50 y/o, complete facial paralysis, immunocompromised patient  

References

• Albrecht, MA. “Treatment of Herpes Zoster in the Immunocompetent Patient.” UpToDate.  21 July 2016 <https://www.uptodate.com/contents/treatment-of-herpes-zoster-in-the-immu... >
• Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. “Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome.” American Journal of Otolaryngology. Nov 8 2011
• Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.