Materiały źródłowe

• #1 SciELO Brazil – Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

  https://www.scielo.br/j/iao/a/t886ttpTDLRTnJY7WC6QdrN/?lang=en

  Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. […] The association of steroids and acyclovir is better than steroids used in monotherapy. […] Patients with Ramsay Hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. […] Treatment of RHS involves high doses of steroids and virostatic agents, especially acyclovir. […] The percentage of patients with a good prognosis varied from 61.1% to 100% in the different studies. […] 68% of the patients with III to VI on the HB scale achieved a good prognosis when treated with steroids without the antiviral agent, versus 70.5% of patients treated with steroids plus antiviral agents.

• #2 Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5063726/

  Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. […] The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. […] Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. […] Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy. […] Treatment of RHS involves high doses of steroids and virostatic agents, especially acyclovir.

• #3 Ramsay Hunt Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1166804-overview

  Treatment goals of Ramsay Hunt syndrome are to minimize disability and relieve symptoms. Clinical evidence shows that earlier start of treatment is correlated with better outcomes. Oral corticosteroids and oral acyclovir are commonly used in the treatment of Ramsay Hunt syndrome. After initiation of medical therapy, the patient with Ramsay Hunt syndrome should be seen in follow-up at 2 weeks, 6 weeks, and 3 months.

• #4 Ramsay Hunt Syndrome Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/1166804-treatment

  Treatment goals of Ramsay Hunt syndrome are to minimize disability and relieve symptoms. Clinical evidence shows that earlier start of treatment is correlated with better outcomes. […] The management of Ramsay Hunt syndrome primarily involves the administration of antiviral agents such as acyclovir or famciclovir, coupled with corticosteroids like prednisone. This therapeutic approach aims to enhance the efficacy against the varicella zoster virus, with corticosteroids potentially reducing inflammation and alleviating neuropathic pain. However, the clinical effectiveness of antiviral medications in this specific context remains unconfirmed. Despite therapeutic interventions, some patients may sustain permanent sequelae, including facial paralysis and hearing loss. […] Evidence from clinical studies indicates that starting treatment in the first week is correlated with the highest rate of improvement, although treatment started later still has some benefit.

• #5 Ramsay Hunt Syndrome – ENT Health

  https://www.enthealth.org/conditions/ramsay-hunt-syndrome/

  Treatment for RHS includes antiviral therapies and corticosteroids. Starting these medications as soon as possible helps improve recovery. […] When symptoms are severe, these medications can be given intravenously (IV) in the hospital. […] Pain control with multiple types of medications is important during treatment and even after the rash goes away and facial movement returns. Because patients have difficulty closing the eye due to facial nerve paralysis, eye moisturization and lubrication is very important. Medication for nausea and dizziness is also helpful during treatment to support recovery.

• #6 Ramsay Hunt syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ramsay-hunt-syndrome/symptoms-causes/syc-20351783

  Prompt treatment of Ramsay Hunt syndrome can reduce the risk of complications, which can include permanent facial muscle weakness and deafness. […] Call your doctor if you experience facial paralysis or a shingles rash on your face. Treatment that starts within three days of the start of signs and symptoms may help prevent long-term complications.

• #7 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1110839

  Ramsay Hunt syndrome is a type of acute herpes zoster, which occurs by reactivation of the varicella-zoster virus at the geniculate ganglion. […] Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome. […] Early treatment with a combination of acyclovir and prednisone is reported to be effective to treat Ramsay Hunt syndrome. […] Antiviral agents such as acyclovir and famciclovir improve acute pain and recovery of lesions from herpes zoster and prevent the occurrence of postherpetic neuralgia. […] Steroids have a strong anti-inflammatory action, which reduces inflammation and edema in the nerves involved in herpes zoster, which can lead to accelerated recovery of the affected nerves. […] The effects of acyclovir-prednisone treatment were investigated in 80 patients with Ramsay Hunt syndrome.

• #8 Ramsay Hunt syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000322

  Prompt combination treatment (within 72 hours) with high-dose oral corticosteroids and antivirals is recommended in all patients. […] Patients with ocular symptoms should be given eye lubricants. In patients who can’t close their eyes, taping the eye shut is recommended to protect the cornea at night. […] The majority of patients will recover their facial movement at least partially with treatment.

• #9 Ramsay Hunt syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ramsay-hunt-syndrome/diagnosis-treatment/drc-20351789

  Prompt treatment of Ramsay Hunt syndrome can ease pain and decrease the risk of long-term complications. Medications may include: […] Antiviral drugs. Medications such as acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex) often help combat the chickenpox virus. […] Corticosteroids. A short regimen of high-dose prednisone appears to boost the effect of antiviral drugs in Ramsay Hunt syndrome. […] Anti-anxiety medications. Drugs such as diazepam (Valium) can help relieve vertigo. […] Pain relievers. The pain associated with Ramsay Hunt syndrome can be severe. Prescription pain medications may be needed.

• #10 Ramsay Hunt syndrome

  https://dermnetnz.org/topics/ramsay-hunt-syndrome

  Full recovery is more likely if antiviral treatment is started within 72 hours of onset of symptoms. Treatment options for Ramsay Hunt syndrome are: […] Aciclovir 800 mg orally five times daily for 7 days […] Valaciclovir 1 g three times daily for 7 days […] Famciclovir 500 mg three times daily for 7 days […] Combination therapy of antiviral treatment and prednisone (60 mg orally daily for 5 days). […] Symptomatic treatment during acute Ramsay Hunt syndrome may include: […] Systemic corticosteroids […] Opioid analgesics […] Anticonvulsants, such as gabapentin and pregabalin […] Ice packs on the blisters […] An eye patch if unable to close an eye […] Artificial tears and lubricating ointments to combat dry eye […] Transcutaneous electrical nerve stimulation (TENS) and vibration […] Tepid topical solution of aluminium sulfate. […] Topical capsaicin can be used for post-herpetic neuralgia but is not well tolerated on facial skin.

• #11 Ramsay Hunt Syndrome and the Pharmacist

  https://www.uspharmacist.com/article/ramsay-hunt-syndrome-and-the-pharmacist

  Recommended pharmacologic therapy for RHS includes a combination of antiviral and corticosteroid medications. Prompt initiation within 72 hours of symptom onset has been associated with significant improvement versus delayed treatment, so rapid diagnosis and management are critical. […] Recommended antivirals include valacyclovir 1 g orally three times daily, famciclovir 500 mg orally three times daily, or acyclovir 800 mg orally five times daily for 7 to 10 days. In more serious cases or in immunocompromised patients, IV acyclovir therapy may be initiated at 10 mg/kg/dose every 8 hours and then be transitioned to oral therapy upon clinical improvement. […] Prednisone 1 mg/kg for 5 days has been recommended in conjunction with antiviral therapy, with or without a tapering regimen. […] Pain management for PHN may be necessary in some RHS patients. Topical treatment with capsaicin cream or patches may provide relief, but application-related AEs such as burning, stinging, and redness might limit use. Patches containing 5% lidocaine have also been approved for the treatment of PHN and have exhibited mixed results in clinical trials.

• #12 Ramsay Hunt Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22843

  Herpes zoster is generally self-limiting in nature. Therefore, the main goals of treatment are to decrease the incidence of late complications, including spastic facial paralysis and postherpetic neuralgia. Multiple studies have shown a significant decrease in long-term complications with the use of oral antivirals and steroids. It is unclear, however, whether these medications decrease the length or severity of acute symptoms. Acyclovir, valacyclovir, and famciclovir have all been studied and found effective. Acyclovir, 500 mg five times a day, is usually the most affordable option. Valacyclovir, 1000 mg three times a day, is easier for most patients to take and appears to be more effective, at least in Bell’s palsy. Another option is famciclovir, 500 mg three times a day, which also appears to be more effective than acyclovir. Antiviral treatment is usually administered for 7 to 10 days; however, some studies have reported prolonged or delayed degeneration of facial nerve axons up to 21 days after paralysis onset, and therefore recommend continuing antiviral therapy for 21 days.

• #13 Bell’s Palsy and Ramsay Hunt Syndrome | Tampa Bay Hearing and Balance Center

  https://www.tampabayhearing.com/ear-education/bells-palsy-and-ramsay-hunt-syndrome/

  In Ramsay Hunt syndrome, a facial palsy caused by the shingles-Zoster-chicken pox virus, the use of early, very high dose antiviral therapy is associated with a markedly improved outcome. […] For Ramsay Hunt patients, the poor quality recovery rate can drop to quite similar to Bells palsy if they are treated early high dose steroids and high dose antiviral medication. […] For those with Ramsay Hunt syndrome, our preference is early, very high dose antiviral medication and high dose steroids, continuing both until at least the 21st day after disorder onset. […] Nevertheless, since nerve swelling seems to be the in-common issue that causes poor quality recovery, many think surgery is indicated for severe Ramsay Hunt facial paralysis.

• #14 Ramsay Hunt Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22843

  High-dose corticosteroids, either oral or intravenous, should be co-administered with antiviral treatment. There is no overall consensus regarding the total duration of steroid treatment, which can vary from 4 to 37 days, but steroids should be prescribed at a high dose. This is typically prednisone 1 mg/kg/day up to a maximum dose of 60 mg, or the equivalent of such, followed by a taper to prevent acute adrenal insufficiency. In a cohort of Ramsay Hunt patients with complete facial paralysis at initial presentation, Furukawa et al. demonstrated a potential benefit of even higher doses of corticosteroid, up to 200 mg with a subsequent 10-day taper, in combination with antiviral therapy. Another modality for corticosteroid treatment is via intratympanic injection. Cadaveric studies have demonstrated dehiscence of the intratympanic segment of the facial nerve in 50-80% of patients. This dehiscence allows for topical administration of a corticosteroid, sparing the patient from the adverse side effects associated with systemic steroids. In one of the few prospective studies on Ramsay Hunt patients, Inagaki et al. showed that concurrent treatment with systemic and daily intratympanic steroid injections for 10 days increased the rate of recovery, with 11 out of 12 patients who initially demonstrated House-Brackmann IV-VI facial paralysis exhibiting full recovery to House-Brackmann I when evaluated 12 months after symptom onset. In a recent meta-analysis evaluating the efficacy of concurrent treatment in Ramsay Hunt syndrome and Bell’s palsy patients, those who received intratympanic steroid injections, in addition to systemic steroids, were found to have a relative reduction in the risk of non-recovery by 64%. Prospective studies are still necessary to confirm the efficacy of intratympanic steroid injections in acute facial paralysis but may be a reasonable adjunct to treatment in Ramsay Hunt patients with moderate to severe facial paralysis.

• #15 Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5063726/

  The percentage of patients with a good prognosis varied from 61.1% to 100% in the different studies. […] More specifically, 51.4% of the patients with facial palsy grade V and VI completely recovered the facial motor function (HB I or II) when treated with steroids plus antiviral agents. […] Kinishi et al compared the evolution of patients with facial palsy due to RHS treated with corticosteroids with or without antiviral agents. They demonstrated better evolution of patients treated with methylprednisolone and acyclovir (93.4% versus 68% of the patients who did not receive acyclovir). […] Overall, patients with Ramsay Hunt syndrome achieved a high rate of complete recovery of the facial nerve function (70.4%) after the different proposed treatments. The combination of steroids and acyclovir reached better recovery rates than steroids in monotherapy.

• #16 SciELO Brazil – Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

  https://www.scielo.br/j/iao/a/t886ttpTDLRTnJY7WC6QdrN/?lang=en

  Kinishi et al compared the evolution of patients with facial palsy due to RHS treated with corticosteroids with or without antiviral agents. They demonstrated better evolution of patients treated with methylprednisolone and acyclovir (93.4% versus 68% of the patients who did not receive acyclovir). […] Overall, patients with Ramsay Hunt syndrome achieved a high rate of complete recovery of the facial nerve function (70.4%) after the different proposed treatments. The combination of steroids and acyclovir reached better recovery rates than steroids in monotherapy.

• #17 Ramsay Hunt Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22843

  Symptomatic management is also critical, particularly for two aspects of Ramsay Hunt syndrome: pain and corneal exposure. Analgesia is often needed with zoster; a multimodal approach with acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and long-acting opioids can all be used. If steroids are prescribed, concomitant NSAID use should generally be avoided to mitigate the risk of enteropathy, ulcer formation, and subsequent gastrointestinal bleeding. Tricyclic antidepressants and gabapentin are useful for the treatment of neuropathic pain and postherpetic neuralgia. Meclizine and benzodiazepines can be effective for managing acute vertigo as well. Artificial tears throughout the day and ocular lubricant ointment at night are helpful for the prevention of exposure keratopathy, and patients with frank lagophthalmos should be instructed in how to stretch the eyelid and how to tape the eye closed at night in such a way as to avoid scratching the cornea in the process. Patients with multiple comorbidities, such as diabetes, old age, hypertension, and immunocompromise, may take longer to recover than most, and they may benefit from the placement of an upper eyelid weight to aid eye closure and prevent exposure keratopathy during the recovery period. Eyelid weight placement is particularly indicated in patients with corneal hypesthesia.

• #18 Ramsay Hunt Syndrome Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/1166804-treatment

  Intravenous high-dose methylprednisolone is not commonly used in the treatment of Ramsay Hunt syndrome, however, it may provide some clinical benefit even if administered late. […] Treatment modalities are further individualized based on the specific clinical manifestations of each patient. Analgesic management may include carbamazepine, an anticonvulsant effective in reducing neuralgic pain. Vertigo may be managed with antihistamines and anticholinergics, while anti-anxiety agents such as diazepam are utilized for symptomatic relief of pain and vertigo. Botulinum toxin type A (Botox) is employed for both neuropathic pain and functional improvement in patients experiencing difficulty in eyelid closure. For those with residual facial weakness, targeted physical therapy is recommended to enhance facial muscle function.

• #19 Ramsay Hunt Syndrome and the Pharmacist

  https://www.uspharmacist.com/article/ramsay-hunt-syndrome-and-the-pharmacist

  In patients with moderate-to-severe PHN, gabapentin and pregabalin are considered first-line agents. Patients should be started on low doses and titrated to the desired effect. […] The use of tricyclic antidepressants (TCAs) such as amitriptyline may be considered in patients with PHN who are unable to tolerate the gabapentinoids or are not experiencing adequate relief with their use. […] Given the risk of abuse and addiction, opioids and tramadol are considered third-line agents for PHN and should be used only under the close supervision of a prescribing physician.

• #20 Ramsay Hunt Syndrome Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/1166804-treatment

  The US Food and Drug Administration (FDA) has approved capsaicin for the management of neuropathic pain associated with postherpetic neuralgia. Early initiation of treatment, preferably within three days of symptom onset, is critical for optimal therapeutic outcomes. […] Protective measures against corneal damage are essential for patients with impaired eyelid closure. This includes the application of artificial tears and lubricating ointments, and in some cases, the use of an eye patch to prevent exposure-related corneal injuries. […] Preventive strategies against the varicella zoster virus encompass vaccination with the chickenpox vaccine in children and the shingles vaccine in individuals aged 50 and older. These vaccinations significantly decrease the risk of viral infection, subsequently reducing the incidence of Ramsay Hunt syndrome.

• #21

  https://journals.lww.com/md-journal/fulltext/2021/10010/a_case_report_of_refractory_otalgia_after_ramsay.18.aspx

  Ramsay Hunt syndrome is a type of herpes zoster infection involving geniculate ganglion and facial nerve. […] The patient was treated with the application of ultrasound-guided pulsed radiofrequency (PRF) to the great auricular nerve. […] The patient experienced significant pain reduction more than 50% on a numeric rating scale after 2 weeks of PRF treatment. […] PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome. […] PRF on the great auricular nerve block showed more long-lasting and potent analgesic effect, although both facial nerve block and great auricular nerve block caused transient symptomatic relief. […] To the best of our knowledge, this is the first report of a patient with Ramsay Hunt syndrome followed by PHN, which was successfully treated with PRF to the great auricular nerve. The interventions to the great auricular nerve could be considered as the therapeutic options for refractory otalgia following Ramsay Hunt syndrome. […] Chronic otalgia might be a type of PHN after Ramsay Hunt syndrome with cervical nerve involvement despite the absence of skin lesions in the cervical area. PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome.

• #22 Ramsay Hunt syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/ramsay-hunt-syndrome

  Strong anti-inflammatory medicamentos called steroids (such as prednisone) are usually given. Antiviral medicines, such as acyclovir or valacyclovir will usually be given. […] Sometimes strong painkillers are also needed if the pain continues even with steroids. While you have weakness of the face, wear an eye patch to prevent injury to the cornea (corneal abrasion) and other damage to the eye if the eye does not close completely. Some people may use a special eye lubricant at night and artificial tears during the day to prevent the eye from drying out. […] If you have dizziness, your provider can advise other medicines.

• #23 Ramsay Hunt Syndrome – Facial Palsy UK

  https://www.facialpalsy.org.uk/causesanddiagnoses/ramsay-hunt-syndrome/

  Prompt treatment (ideally within three days of onset of symptoms) with antiviral medication (e.g. acyclovir). […] Prompt treatment with a short-course of high dose steroids is also recommended. […] Painkillers […] Eye lubrication for the unblinking eye (preservative-free if used more than four times per day).

• #24 For Providers | RHSF

  https://www.ramsayhuntfoundation.org/for-healthcare-providers

  What is Ramsay Hunt Syndrome? Treatment Options […] Recommend starting treatment upon initial evaluation of the patient. Best outcomes are noted when treatment is started within 72 hours of initial symptom onset. […] For all patients: […] Steroids […] 60 mg of Prednisone daily for 7-10 days […] Antivirals […] 1000 mg Valtrex TID for 7 days […] Refer to Otolaryngology as well as Vestibular Therapy and Mental Health Therapy, as needed […] For patients with incomplete eye closure: […] Eye Protection […] Drops (ex: Refresh Tears) Q2H and PRN […] Eye ointment (ex: Refresh PM) nightly […] Night time care: patients should be instructed to place ointment in the eye, physically close the eye and then tape the upper eyelid to the upper cheek to keep the eye lubricated and closed while asleep. […] For those with a red or irritated eye – consider referral to ophthalmology.

• #25 Ramsay Hunt Syndrome | Mass Eye and Ear

  https://www.masseyeandear.org/conditions/ramsay-hunt-syndrome?TRILIBIS_EMULATOR_UA=ulvhbdkubeqb%3Fcmp%3Dhrgn%3Fcmp%3Dhrgn%3Fcmp%3Dhrgn

  Ramsay Hunt syndrome is treated with both steroids and antiviral medications, similar to Bell’s palsy, but usually is somewhat more severe and it takes longer for the facial paralysis to recover. […] In extremely rare cases, people do not experience meaningful recovery, and require facial reanimation procedures to bring back facial movement. […] Much more commonly, people recover, but to an over-recovered state where the face is too tight, and they require the same types of interventions that people with Bells palsy do. Physical therapy, Botox injections, selective neurectomy, and minor office procedures can be very effective at resolving these symptoms.

• #26 ALL ABOUT RAMSAY HUNT SYNDROME | Facial Paralysis Institute

  https://facialparalysisinstitute.com/blog/all-about-ramsay-hunt-syndrome/

  The ideal treatment for Ramsay Hunt syndrome depends on the patient. In some instances, a doctor will prescribe antiviral drugs to limit the effects of the varicella zoster virus. A doctor may also recommend corticosteroids to boost the effectiveness of antiviral drugs. […] In the event that Ramsay Hunt syndrome causes severe facial paralysis, Dr. Azizzadeh can help. At this point, Dr. Azizzadeh can assess a patient to determine what treatments can be used to address this issue. […] Dr. Azizzadeh can use Botox injections to treat Ramsay Hunt syndrome facial paralysis. He can target specific muscles in the face and use Botox to relax them and create a more balanced and symmetrical appearance. […] Botox can be a safe and effective treatment for many Ramsay Hunt syndrome patients coping with facial paralysis. However, the results of Botox injections last up to four months. Therefore, patients may require periodic Botox treatments to treat their facial paralysis symptoms.

• #27 Ramsay Hunt Syndrome Treatment – Facial Paralysis Institute Ramsay Hunt Treatment

  https://facialparalysisinstitute.com/treatments/ramsay-hunt-syndrome/

  Selective neurolysis is one of the best Ramsay Hunt syndrome treatments ever developed. Pioneered by Dr. Azizzadeh, selective neurolysis involves meticulous mapping of the facial nerve. Dr. Azizzadeh then selectively reduces facial nerve activity to help recreate a natural smile. […] Botox is a safe, effective treatment for Ramsay Hunt syndrome. It reduces tension in areas of the face that are hyperactive, as well as treats unwanted muscle movements in the face. Additionally, Botox treatments may be used in combination with neuromuscular retraining to help a Ramsay Hunt syndrome patient achieve the best-possible results. […] The masseter to facial nerve transfer is one of the most cutting-edge Ramsay Hunt syndrome treatment options. It involves making an incision near the front of a Ramsay Hunt syndrome patients ear, followed by sewing the facial nerve and masseteric nerve together. That way, a Ramsay Hunt syndrome patient can restore his or her natural smile in the months following the procedure.

• #28 Ramsay Hunt Syndrome | Doctor Be Clinic | (Causes & Treatment)

  https://www.doctorbe.com/facial-paralysis-and-synkinesis/facial-paralysis/ramsay-hunt-syndrome

  Masseter nerve transfer, another treatment for Ramsay hunt syndrome, is a surgical procedure used to treat facial paralysis. In this procedure, an intact nerve (usually the masseter nerve) is connected to the paralyzed facial muscles to regain control of the muscles. […] Botox, which is a very easy treatment method, can cure facial paralysis caused by ramsay hunt syndrome. With Botox application, the signals transmitted from the nerves to the muscles are temporarily blocked, allowing the muscles to relax. […] Facial paralysis in Ramsay hunt syndrome can be treated with selective neurolysis. In particular, the nerves damaged by the disease are completely or partially removed and the pain or spasms on the face are treated. Therefore, facial paralysis caused by ramsay hunt can be resolved in a short time thanks to this procedure.

• #29 Ramsay Hunt Syndrome | Doctor Be Clinic | (Causes & Treatment)

  https://www.doctorbe.com/facial-paralysis-and-synkinesis/facial-paralysis/ramsay-hunt-syndrome

  Physical Therapy and Rehabilitation: Conditions such as facial paralysis that occur in the later stages of the disease can be corrected with physical therapy. Because physical therapy generally strengthens the facial muscles and increases their flexibility. Therefore, physical therapy should also be emphasized. […] Facial Paralysis Caused by Ramsay Hunt Syndrome Treatments are very comprehensive and specialized treatments. We can divide these treatments into 4 groups. These are; botox procedure, selective neurolysis application, Masseter nerve transfer and cross facial nerve transplantation. […] One of the most important treatments for Ramsay hunt syndrome (RHS), cross facial paralysis is a very important procedure. In this way, the intact facial muscles or paralyzed facial muscles are completely supported and the problem of balance and function is completely eliminated.

• #30 Ramsay Hunt Syndrome in Boston | Hadlock Facial Plastic Surgery

  https://www.hadlockfacialplasticsurgery.com/conditions/ramsay-hunt-syndrome/

  To address recovery and improve overall facial appearance and function in Ramsay Hunt Syndrome, several treatment options may be considered: […] Physical therapy plays a crucial role in helping individuals with Ramsay Hunt Syndrome regain control over their facial muscles. Therapists use targeted exercises and techniques to enhance facial symmetry and movement. […] Anti-inflammatory medications (steroids) work to address inflamed nerves and reduce pain. When the medication is started within three days of the onset of symptoms, the recovery rate is quite high. Antiviral medications may also be prescribed. […] In some cases, additional treatments may be recommended to address specific issues related to Ramsay Hunt Syndrome. The choice of intervention depends on the individuals symptoms and condition.

• #31 Ramsay Hunt Syndrome | Norelle Health

  https://norellehealth.org/conditions/ramsay-hunt-syndrome/

  Physical Therapy: To improve muscle strength and coordination in the face. Techniques: Facial Exercises: Specific exercises to help retrain and strengthen facial muscles. Biofeedback: Using electronic monitoring to teach patients how to control muscle movements. […] Occupational Therapy: To help patients cope with daily activities affected by facial paralysis. Techniques: Adaptive Strategies: Teaching new ways to perform tasks that are impacted by muscle weakness. […] Speech Therapy: To address speech and swallowing difficulties. Techniques: Speech Exercises: To improve articulation and communication. Swallowing Techniques: To ensure safe and effective swallowing. […] Surgical Interventions: For cases where there is no improvement with other treatments. Types: Facial Nerve Decompression: Surgery to relieve pressure on the facial nerve. Nerve Grafting: In severe cases, grafting a nerve from another part of the body to replace or repair the damaged facial nerve. […] Regular follow-up with a healthcare provider is essential to monitor progress and adjust treatments as needed. Early and comprehensive treatment can significantly improve outcomes and reduce the risk of long-term complications.

• #32

  https://journals.lww.com/md-journal/fulltext/2018/04270/treatment_of_ramsay_hunt_s_syndrome_with_multiple.87.aspx

  In the treatment of RHS, the combination of acyclovir and prednisone is the most recommended therapy. […] Therefore, use of antiviral agents for an insufficient period time and/or insufficient anti-inflammatory effect of corticosteroids on neuroinflammation of the cranial nerves may lead to late involvement of other cranial nerves. […] However, considering that there is no significant recovery until 13 months, our case suggests that long-term rehabilitation and clinical follow-up of more than one year may be important in RHS patients with severe dysphagia. […] Our case gives us the lesson that optimal doses of acyclovir and corticosteroids for a sufficient period time are important to prevent progression of multiple cranial involvements in RHS, and swallowing difficulty in RHS patients with multiple cranial nerve involvement can be improved through long-term rehabilitation even if there is no improvement for more than one year.

• #33 Ramsay Hunt Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22843

  Further surgical intervention in Ramsay Hunt patients in the acute setting is controversial. Generally, surgical decompression is considered to be beneficial in Bell’s palsy patients if electrodiagnostic testing shows 90% degeneration of the facial nerve without the presence of voluntary motor potentials, the affected side is completely paralyzed, and if surgery is performed within 14 days from paralysis onset. Whether or not these same parameters can be applied to prognosticate patients with Ramsay Hunt syndrome is unclear. Some surgeons may choose to offer surgical decompression to patients within the 14-day time period, or even up to 50 days after onset. Although the role of surgical intervention in improving recovery in Ramsay Hunt syndrome is unclear, it should be emphasized that decompression should only be offered to select patients with a poor prognosis at baseline. Due to the relatively rare number of Ramsay Hunt cases, and even rarer number of Ramsay Hunt patients who fail to show some degree of recovery during or after medical treatment, it has been difficult to draw conclusions regarding the optimal candidacy and timing of surgery. Surgical decompression of the facial nerve has been achieved via either a transmastoid or middle cranial fossa approach.

• #34 ALL ABOUT RAMSAY HUNT SYNDROME | Facial Paralysis Institute

  https://facialparalysisinstitute.com/blog/all-about-ramsay-hunt-syndrome/

  Along with Botox, Dr. Azizzadeh offers several surgical treatment options. Dr. Azizzadeh recommends surgery if it can be administered safely and deliver long-lasting results. He crafts an appropriate treatment plan to restore facial animation for his patient. This plan can include a cross facial nerve transplant, masseter-to-facial nerve transfer, or other surgical procedures. […] Ramsay Hunt syndrome can cause facial paralysis that hampers a persons facial appearance. By meeting with Dr. Azizzadeh, a Ramsay Hunt syndrome patient can explore treatment options for facial paralysis. Dr. Azizzadeh can help this patient identify the ideal treatment to achieve long-lasting relief from their facial paralysis symptoms.

• #35 Ramsay Hunt Syndrome Treatment – Facial Paralysis Institute Ramsay Hunt Treatment

  https://facialparalysisinstitute.com/treatments/ramsay-hunt-syndrome/

  A cross facial nerve transplant is a two-stage Ramsay syndrome treatment. Initially, nerve grafts are harvested from a patients lower leg and attached to his or her facial nerve. During the second stage of this Ramsay Hunt syndrome treatment, the gracilis muscle free flap is harvested from a patients inner thigh and connected to the cross-facial nerve graft and artery or vein in the neck. This ultimately helps a patient restore natural facial movements. Meanwhile, a patient may also require physical therapy following a cross facial nerve transplant procedure. […] The ideal treatment for Ramsay Hunt syndrome varies based on the patient and the extent of their facial paralysis. To determine the best course of action, Dr. Azizzadeh consults with a patient, reviews their medical history, and evaluates their symptoms.

• #36 Ramsay Hunt Syndrome: Causes, Symptoms, Treatment, and Cost

  https://www.lybrate.com/topic/ramsay-hunt-syndrome

  The best treatment for Ramsay Hunt syndrome are: […] Physical therapy can help to improve coordination and balance, and may involve exercises to strengthen the facial muscles. […] Eye care: If the eye is affected by Ramsay Hunt syndrome, it is important to protect it from damage and to use artificial tears to keep the eye moist. […] Supportive care: Overall health may be enhanced by getting enough rest, eating a balanced diet, and drinking enough water. […] Myringotomy – A surgical technique where a tiny incision is made in the eardrum to drain fluid that has accumulated in the middle ear or alleviate pressure. […] Vestibular nerve section – A surgical procedure that involves cutting the vestibular nerve to alleviate vertigo and dizziness. […] Facial nerve decompression – A surgical procedure that involves removing a portion of a bony canal to decompress the facial nerve and reduce inflammation, potentially improving facial nerve function.

• #37 Ramsay Hunt syndrome – Primary Care Notebook

  https://primarycarenotebook.com/pages/ear-nose-and-throat/ramsay-hunt-syndrome

  The prognosis can be improved by treatment with acyclovir. […] Standard first-line treatment for herpes zoster infections at sites in the body other than the ear is the antiviral agent acyclovir, which is given either intravenously or orally. Other antiviral agents that may be prescribed include valacyclovir, famcyclovir or brivudin. […] A more recent review states: early treatment with a combination of acyclovir and prednisone is reported to be effective to treat Ramsay Hunt syndrome. […] Evidence shows a decrease in long-term complications with the use of oral antivirals and steroids. […] Surgical management in the acute setting is controversial. […] In the long term, the management of synkinesis can be accomplished via both conservative and surgical approaches. […] Conservative approaches include: massage and physical therapy, chemodenervation with botulinum toxin. […] Surgical management of synkinesis includes selective neurectomy and/or myomectomy, or even nerve or functional free muscle transfer to improve smile symmetry.

• #38 Ramsay Hunt Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22843

  In the long term, the management of synkinesis can be accomplished with both conservative and surgical approaches. Conservative approaches include massage and physical therapy as well as chemodenervation with botulinum toxin. Surgical management of synkinesis may involve selective neurectomy and/or myomectomy, or even nerve or functional free muscle transfer to improve smile symmetry.

• #39 Treatment of Ramsay Hunt Syndrome | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-11-3-8

  The effect of acyclovir-prednisone treatment in 80 patients with Ramsay Hunt syndrome was analyzed retrospectively at the Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan. […] Treatment with acyclovir, 250 mg tid by intravenous drip or 800 mg 5x daily orally, and prednisone, 1 mg/kg day iv or orally, was started 1 to 10 days after onset of facial paralysis. Recovery from paralysis was complete in 21 (75%) of 28 patients treated within 3 days of onset, and in only 7 (30%) of 23 whose treatment was delayed more than 7 days. […] Early administration of acyclovir and prednisone, within the first 3 days of onset, results in 75% rate of facial nerve recovery and less likelihood of residual nerve deafness.

• #40

  https://healthmatch.io/shingles/ramsay-hunt-syndrome

  Pain relievers. You can treat the pain associated with Ramsay Hunt Syndrome with over-the-counter or prescription pain medicines. […] Using a cold compress is one of the more non-invasive ways to deal with the discomfort of Ramsay Hunt syndrome. […] In the case of total facial paralysis, your doctor may recommend surgical intervention. The operation can lessen the pressure on your facial nerves, improving some symptoms. […] Antiviral medications can help. If you start taking them early, you have a greater chance of making a full recovery. The long-term prognosis is better if diagnosis occurs early and the disease is treated quickly with antiviral therapy. With treatment, over 70% of those affected by Ramsay Hunt syndrome will regain full or nearly full use of their faces.

• #41 Ramsay Hunt syndrome — entsho.com

  https://entsho.com/ramsay-hunt-syndrome

  The prognosis for facial nerve function in Ramsay Hunt syndrome is poorer than for Bells palsy. Although evidence is limited, early recognition and commencement of steroids and antiviral therapy within the first 72 hours will maximise the chance of good recovery (70% for timely treatment versus 50% if delayed). […] Oral aciclovir 800mg five times daily for 7 days […] Oral prednisolone 40mg OD for 7 days […] IV aciclovir, steroids and gastroprotection can be given if the patient requires admission and cannot tolerate these treatments orally. […] Maximum recovery may take up to 12 months. In persistent facial palsy, the eye can be protected by implanted gold/platinum weights in the eyelid or tarsorraphy. Facial reanimation by static techniques, or dynamic free muscle transfer and cross-over nerve grafting can also be performed.

• #42 Ramsay Hunt Syndrome – A Diagnostic Dilemma – MedCrave online

  https://medcraveonline.com/JOENTR/ramsay-hunt-syndrome-ndash-a-diagnostic-dilemma.html

  Among the agents most frequently used to treat these conditions are steroids, antiviral agents vasodilators, and multivitamins. Due to the anti-inflammatory effect of steroids, an enhanced recovery can be achieved in patients with steroid treatment in Bell palsy and Ramsay Hunt syndrome. […] In addition, the treatment for patients with Ramsay Hunt with antiviral agents may prevent disease progression and improve prognosis by inhibiting the spread of herpes zoster virus. […] The most recommended therapy for RHS is the combination of acyclovir and prednisone. […] Acyclovir is an effective antimicrobial agent against actively replicating herpes zoster viruses. […] Adjunctive steroid therapy can be helpful in the management of the facial paralysis of RHS. […] To conclude, although patients with Ramsay Hunt syndrome have poorer prognosis than do those with Bells palsy, early combination therapy of steroids with antivirals within 3days of the onset of facial palsy is beneficial.

• #43 Ramsay Hunt Syndrome | UNC Facial Nerve Center

  https://www.med.unc.edu/ent/facialnervecenter/conditions/2567-2/

  If the diagnosis is confirmed to be Ramsay Hunt Syndrome, patients will typically be prescribed high-dose steroids (e.g., Prednisone) and an antiviral (e.g., Valtrex). […] Patients with Ramsay Hunt Syndrome have many treatment options to improve their facial function and symmetry. These treatments can improve smile symmetry, facial symmetry, facial synkinesis, and neck and face tightness. Potential treatment options for patients with Ramsay Hunt Syndrome include: […] Rarely, patients with Ramsay Hunt Syndrome do not recover significant facial movement and reanimation procedures such as cross-facial nerve grafts and nerve transfers can be performed to restore facial function and symmetry.

• #44 An unexpected case of Ramsay hunt syndrome: case report and literature review | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-6-337

  Despite the absence of RCTs on RHS management, when considering the possibility of lifelong facial paralysis and hearing loss, experts recommend combination antiviral and corticosteroid therapy within the first 72 h of symptoms. […] In our case, acyclovir was replaced by 1 g valacyclovir TID for 10 days, with successful outcomes.

• #45 Ramsay Hunt Syndrome Treatment – Facial Paralysis Institute Ramsay Hunt Treatment

  https://facialparalysisinstitute.com/treatments/ramsay-hunt-syndrome/

  Initially, Dr. Azizzadeh may recommend antiviral drugs, corticosteroids, or other medications to treat pain associated with Ramsay Hunt syndrome. These Ramsay Hunt syndrome treatments can provide short-term pain relief and may be used in combination with a surgical or non-surgical procedure to treat Ramsay Hunt syndrome. […] Dr. Azizzadeh developed a custom plan for a Facial Paralysis Institute Ramsay Hunt patient. The plan is designed to help a patient simultaneously reduce or eliminate their symptoms and minimize the risk of complications. […] Dr. Azizzadeh can offer insights into different options to treat Ramsay Hunt syndrome and help a patient decide which treatment is ideal. To schedule a Ramsay Hunt syndrome treatment consultation with Dr. Azizzadeh, please call us today at (310) 657-2203.

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