When diagnosing a condition we must be aware that some conditions may be very similar in their symptoms and Ramsay Hunt syndrome and Bell’s palsy are the perfect examples of how easy is to get it wrong.
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One single detail may put us on a completely wrong path: the rash. But let's see the common symptoms of both conditions.
Symptoms of both conditions are facial numbness, difficulty moving the parts of the face, one side of the face drops, facial pain, dry eye, watery eyes, drooling, and taste changes.
In both conditions, paralysis is usually on one side of the face. There are also tinnitus and hearing loss.
Now, a typical Ramsay Hunt syndrome is a red rash with filled blisters on, in, and around one ear. But that's typical, it may appear without that symptom and that's when the problem occurs. Bell’s palsy does not cause a rash to form and if Ramsay didn't cause that rash, we have two conditions very similar and very difficult to diagnose.
Let's see what causes Ramsay Hunt. In people that had chickenpox the virus that causes it stays in nerves. It may, or may not, activate years later and cause the syndrome. And of course, it affects facial nerves.
It's more common in older adults, typically affecting people older than 60. Ramsay Hunt syndrome is rare in children.
Complications of Ramsay Hunt syndrome may include permanent hearing loss and facial weakness. They may be temporary but if the treatment is not given promptly they may become permanent.
When you can't close your eye thanks to Ramsay Hunt syndrome your eye's cornea may be damaged which leads to pain and blurred vision.
And there's another awful problem: if your nerves are damaged you may develop postherpetic neuralgia. That means that the messages sent by damaged nerve fibers become confused and exaggerated. That causes pain even after other symptoms of Ramsay Hunt syndrome have gone. And that may last for a long time.
So, the question is how long does it last? All patients recover from Ramsay Hunt syndrome.
Recovery ranges from complete recovery to recovery to some degree, and about 70% of Ramsay Hunt patients will recover satisfactorily but not fully.
Generally speaking, the prognosis for Ramsay Hunt syndrome is worse than that for Bell's palsy.
When we are talking about Bell's palsy we don't know what causes it. We know it may be related to a viral infection but we can't name the exact virus like in Ramsay Hunt.
Patients that have cold sores and genital herpes, infectious mononucleosis, chickenpox, rubella, mumps, flu, adenovirus, or some other viruses may develop Bell's palsy.
The nerve that controls facial muscles becomes inflamed and swollen and it affects tears, saliva, taste, and a small bone in the middle of the ear.
While in Ramsay Hunt syndrome we may search for a specific virus, for Bell's palsy there is no specific test, just a doctor's experience and usual tests such as CT and MRI.
But then again we have problems. Ramsay Hunt affects around 5 per 100,000 people per year while Bell's palsy affects around 15 to 30 per 100,000 people per year. That means that Ramsay Hunt is a rare syndrome and your clinician may not be aware of it.
The second problem is that we can use laboratory test for virus infections, it can show was there an infection but can't by itself confirm it's Ramsay Hunt syndrome.
That's why the doctor will largely rely on your complete medical history, your visits to the doctor, your overall state, and all symptoms included. In other words, the experience is very important here. Unfortunately, an inexperienced doctor will just say it's Bell’s palsy, usually.
In both cases it is very important to act promptly, because the outcome is much better if we act quickly and give proper medication.
As an example, Bell's palsy may be also caused by a benign tumor, that's why if you have tinnitus the whole team will examine you as fast as possible to determine what it is.
Some signs that may help to establish a diagnosis are herpes and the start of the pain.
If there's oral herpes that seems to doesn't go away for days it's time to see a doctor who must take that into account.
If the pain in the ear started suddenly, it's time to visit the doctor who must respond quickly.
The important thing when setting a diagnosis, a very important thing, is to have a complete picture.
For example, some doctors may say that oral herpes is unrelated to the ear pain on the other side of the face, but it must be taken into account. These conditions are such that we must take every possible detail into account to be able to help the patient.
Another thing is the speed of reaction. If the patient gets corticosteroids or antibiotics in time if the diagnosis supports that, there's no need to wait for CT or MRI, especially in environments where waiting may be in weeks or months.
The speed is crucial here. Whatever we decide, we must act quickly. In the other case, the patient may be left with a permanently damaged face. ■