Which diagnosis is described by severe ear pain, a vesicular rash near the ear, and facial weakness on the affected side?

Which diagnosis is described by severe ear pain, a vesicular rash near the ear, and facial weakness on the affected side?

• A. Bell palsy
• B. Otitis externa
• C. Acoustic neuroma
• D. Ramsay Hunt syndrome (herpes zoster oticus)

Answer: (D)

This scenario is Ramsay Hunt syndrome, a reactivation of varicella-zoster virus in the facial nerve near the ear. The combination of severe ear pain, a vesicular rash around the ear, and ipsilateral facial weakness is classic for herpes zoster oticus with facial nerve involvement. The virus reactivates in the geniculate ganglion of the seventh cranial nerve and can affect adjacent structures, sometimes including the vestibulocochlear nerve, leading to additional symptoms like hearing loss or vertigo. Bell palsy can cause facial weakness but typically lacks a vesicular eruption and prominent ear pain. Otitis externa may cause ear pain and visible canal inflammation but does not present with a vesicular rash or facial paralysis on the same side. An acoustic neuroma causes gradual, progressive unilateral facial weakness and hearing loss without a vesicular eruption or acute ear pain. Management focuses on antiviral therapy (such as acyclovir or valacyclovir) often combined with corticosteroids, ideally started within 72 hours of onset, along with pain control and rehabilitation as needed. Early treatment improves the chance of complete facial recovery and reduces the risk of persistent weakness.

This scenario is Ramsay Hunt syndrome, a reactivation of varicella-zoster virus in the facial nerve near the ear. The combination of severe ear pain, a vesicular rash around the ear, and ipsilateral facial weakness is classic for herpes zoster oticus with facial nerve involvement. The virus reactivates in the geniculate ganglion of the seventh cranial nerve and can affect adjacent structures, sometimes including the vestibulocochlear nerve, leading to additional symptoms like hearing loss or vertigo.

Bell palsy can cause facial weakness but typically lacks a vesicular eruption and prominent ear pain. Otitis externa may cause ear pain and visible canal inflammation but does not present with a vesicular rash or facial paralysis on the same side. An acoustic neuroma causes gradual, progressive unilateral facial weakness and hearing loss without a vesicular eruption or acute ear pain.

Management focuses on antiviral therapy (such as acyclovir or valacyclovir) often combined with corticosteroids, ideally started within 72 hours of onset, along with pain control and rehabilitation as needed. Early treatment improves the chance of complete facial recovery and reduces the risk of persistent weakness.