Prognostic Factors in Herpes Zoster Oticus (Ramsay Hunt Syndrome) : Otology & Neurotology

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Facial Nerve

Prognostic Factors in Herpes Zoster Oticus (Ramsay Hunt Syndrome)

Coulson, Susan*; Croxson, Glen R.*; Adams, Roger*; Oey, Victoria

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Otology & Neurotology 32(6):p 1025-1030, August 2011. | DOI: 10.1097/MAO.0b013e3182255727



To determine if an accurate prognosis can be made in patients with Herpes zoster oticus (HZO), facial nerve outcomes were assessed at 1-year after onset and compared with symptoms and signs at presentation.

Study Design: 

Individual retrospective cohort study of 101 records in a case series (level of evidence: Level 2b).


Symptoms, signs, audiology, and treatment records were analyzed to determine their association with facial nerve outcome at 1 year.


Mean improvement at 1 year for the 101 patients was 3 House-Brackmann (HB) grade units. Initially, severity ranged from HB III to HB VI. Mean recovery was significantly greater for those patients who were initially more affected, although at 1 year, they had still not recovered to the same grade as those initially less affected. Having both incomplete eye closure and a dry eye was associated with less recovery at 1 year. The use of prednisone combined with an antiviral agent, and begun at or after Day 5 of the illness, was related to a better facial nerve outcome. No other symptom, sign, or audiologic feature was of prognostic value.


All patients with HZO improved facial function to some degree, with the mean gain at 1 year after onset being 3 HB grade units. Improvement was less for patients who initially had both incomplete eye closure and dry eye. The group who received a combination of an antiviral medication with steroids given after 5 days had the best facial nerve outcome.

© 2011 Otology & Neurotology, Inc.

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