A careful history must be obtained in patients with suspected Ramsay Hunt syndrome.
Patients usually present with paroxysmal pain deep within the ear. The pain often radiates outward into the pinna of the ear and may be associated with a more constant, diffuse, and dull background pain.
The onset of pain usually precedes the rash by several hours and even days.
Classic Ramsay Hunt syndrome can be associated with the following:
Vesicular rash of the ear or mouth (as many as 80% of cases)
The rash might precede the onset of facial paresis/palsy (involvement of the seventh cranial nerve [CN VII])
Ipsilateral lower motor neuron facial paresis/palsy (CN VII)
Vertigo and ipsilateral hearing loss (CN VII)
Tinnitus
Otalgia
Headaches
Dysarthria
Gait ataxia
Fever
Cervical adenopathy
Facial weakness usually reaches maximum severity by 1 week after the onset of symptoms.
Other cranial neuropathies might be present and may involve cranial nerves (CNs) VIII, IX, X, V, and VI.
Ipsilateral hearing loss has been reported in as many as 50% of cases.
Blisters of the skin of the ear canal, auricle, or both may become secondarily infected, causing cellulitis.
Poor prognostic factors for good functional recovery include the following:
Age older than 50 years
Complete facial paralysis
Lack of CN VII nerve excitability