A patient present painful vesicles in ear, and tongue. He is also complaining of facial weakness and hearing loss. Dignosis is -

Ans. is 'c' i.e., Ramsay hunt syndromeRamsay hunt syndromeo It is lower motor neuron type of facial palsy due to Varicella (herpes) zoster. Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on anterior two third of tongue. It may involve other cranial nerves-V, VIII, IX and X and cervical branches (C2, C3 & C4) that have anastomotic communications with facial nerve. This results in features like:Anaesthesia of faceGiddinessHearing impairment along with VII nerve palsy.o The mechanism of disease is reactivation of the latent varicella zoster virus in the geniculate ganglion. The onset of palsy is preceeded by pain which may persist & become excruciating. When the rash is absent it is known as zoster sine herpete.o The prognosis of Ramsay Hunt syndromr is worse than Bells palsy. Persistent weakness is observed in 30-50% of patients and only 10% recover completely after complete loss of function without treatment.o Treatment recommended is prednisone (steroid) combined with acyclvir.