Bell's palsy and Ramsay Hunt

Question 1

What is Bells Palsy?

Answer 1

Acute unilateral idiopathic facial nerve paralysis
Could be a viral cause but uncertain

Question 2

What are features of Bells Palsy?

Answer 2

Rapid onset facial muscle weakness
Unilateral and involves upper and lower parts of face (UMN lesions spares forehead)
May have postauricular pain
Altered taste
Dry eyes
Hyperacusis

Question 3

What is the management of Bells Palsy?

Answer 3

1) Oral prednisolone 50-60mg OD for 10 days
- eye care= lubricating drops and tape close at bedtime if required

Antivirals alone not recommended- can be used in combined with steroids but uncertain whether change anything

Question 4

What is the follow up and prognosis of Bell’s Palsy?

Answer 4

If no improvement after 3 weeks- refer to ENT

Most people recover within 3-4 months
If untreated 15% have permanent moderate to severe weakness

Question 5

What is Ramsay Hunt Syndrome?

Answer 5

Reactivation of VZV in geniculate ganglion on 7th cranial nerve

Question 6

What are the clinical symptoms of Ramsay Hunt Syndrome?

Answer 6

Facial droop- acute LMN palsy
Ear pain
Painful, erythematous vesicular rash within ear canal and oropharynx
SNHL, vertigo, tinnitus, hyperacusis if vestibulocochlear nerve involvement
Preceding flu like illness
Lost of taste on anterior 2/3 of tongue

Question 7

What is the management of Ramsay Hunt Syndrome?

Answer 7

1) Antivirals e.g. aciclovir and steroids 60mg OD for 5 days