Ramsay Hunt syndrome following middle ear surgery

We present a 59-year-old woman with facial palsy 3 weeks after a right-sided tympanoplasty surgery via the endaural approach. Physical examination showed a House–Brackman grade III right-sided facial palsy. Two days after facial palsy, swelling and vesicles over the right auricle were noted (Figure 1A). Under the impression of Ramsay Hunt syndrome characterized by acute facial palsy associated with a herpetic eruption on the auricle, the patient was treated with a 2-week oral Famvir (250 mg/tid) and tapered dose of oral prednisolone (1 mg/kg). One week after treatment, the vesicles formed a herpetic crust over the auricle (Figure 1B). The patient's facial palsy abated within 2 weeks of treatment. The appearance of the auricle and external auditory canal completely subsided after 2 months (Figure 1C). The perforated eardrum of the right ear was successfully reconstructed and the patient's hearing acuity improved after 6 months of follow-up.

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