Ramsay-Hunt Syndrome

Ramsay Hunt syndrome occurs when latent varicella-zoster virus (VZV) reactivates in the geniculate ganglion of cranial nerve VII, the facial nerve. Reactivation produces neuritis, edema, and impaired conduction along the nerve. Because the facial nerve travels through the narrow bony fallopian canal, swelling can compromise its function and cause an ipsilateral peripheral facial palsy. The classic pattern is same-side facial paralysis, severe ear pain, and a vesicular rash in or around the ear. The rash may appear before or after the weakness, so a patient does not need to report all three findings at the same moment. Lesions may be seen on the pinna or in the auditory canal; inspection of the ear is therefore part of the neurological assessment, not an incidental skin check. The geniculate ganglion lies close to cranial nerve VIII. Inflammation in this region can affect hearing and vestibular function, producing tinnitus, hearing loss, vertigo, nausea, or imbalance. These findings broaden the assessment beyond facial symmetry.