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

Ramsay Hunt syndrome 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 the 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 face Giddiness Hearing impairment along with VII nerve palsy. The mechanism of disease is a reactivation of the latent varicella-zoster virus in the geniculate ganglion. The onset of palsy is preceded by pain which may persist & become excruciating. When the rash is absent it is known as zoster sine herpete. The prognosis of Ramsay Hunt syndrome is worse than Bells Palsy. Persistent weakness is observed in 30- 50% of paents and only 10% recover completely aer complete loss of function without treatment. Treatment recommended is prednisone (steroid) combined with acyclovir