Ramsay Hunt syndrome (RHS), also known as herpes zoster oticus, is a rare neurological condition caused by the reactivation of the varicella zoster virus (the virus that causes chickenpox and shingles) in the facial nerve. It typically presents with a triad of symptoms: sudden-onset unilateral peripheral facial palsy (facial paralysis), severe ear or facial pain, and a vesicular rash (fluid-filled blisters) on or around the ear, although not all symptoms may appear simultaneously. Additional symptoms can include vertigo, hearing loss, tinnitus (ringing in the ear), altered taste, dry eyes or mouth, and oral lesions. RHS primarily affects adults, particularly those over 50 or who are immunocompromised, and is a significant cause of facial nerve paralysis second only to Bell’s palsy. Diagnosis is mainly clinical, sometimes supported by polymerase chain reaction (PCR) tests of vesicular lesions. Treatment involves prompt administration of high-dose oral corticosteroids and antiviral medications within 72 hours of symptom onset, which improves recovery chances. Supportive care includes eye protection in patients with impaired eyelid closure. The majority of patients experience partial to full recovery of facial nerve function over weeks to months, but some may have lasting facial weakness or other complications. RHS is more complex than Bell’s palsy and can have additional neurological effects due to involvement of nearby cranial nerves. Key clinical features:

• Sudden facial weakness or paralysis on one side
• Severe ear or facial pain
• Painful vesicular rash on the ear, external auditory canal, or mouth
• Possible hearing loss, tinnitus, vertigo
• Taste changes and dry eyes or mouth
• Rash and paralysis may not occur simultaneously

Caused by reactivation of latent varicella zoster virus in the geniculate ganglion of the facial nerve. Treatment: Early corticosteroids and antiviral therapy, eye care, and pain management Prognosis: Most recover partially or fully, but some experience long-term effects This syndrome is important to recognize early to reduce complications and improve outcomes.