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Updated: Jun 27, 2026

Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique
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Ramsay Hunt syndrome presenting as simple otitis externa.

Daniel Kim1, Munsif Bhimani

  • 1Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. dkim000@gmail.com

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|November 21, 2008
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Summary

Ramsay Hunt syndrome, a rare complication of herpes zoster, can be misdiagnosed due to delayed symptom presentation. Early recognition of otalgia, vesicles, and facial paralysis is crucial for timely management.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Ramsay Hunt syndrome (RHS) is a rare neurological complication of varicella zoster virus (VZV) reactivation.
  • VZV latency in the geniculate ganglion can lead to RHS, presenting with otalgia, auricular vesicles, and facial paralysis.

Observation:

  • A patient initially diagnosed with otitis externa presented with otalgia.
  • The condition progressed to include auricular vesicles and peripheral facial paralysis, characteristic of RHS.
  • Delayed diagnosis occurred due to the initial, incomplete symptom presentation.

Findings:

  • RHS diagnosis requires recognizing the triad of otalgia, auricular vesicles, and facial nerve palsy.
  • Varicella zoster virus reactivation in the geniculate ganglion is the underlying cause.
  • Misdiagnosis as otitis externa is possible if all symptoms are not present initially.

Implications:

  • Prompt diagnosis and treatment of RHS are essential to prevent long-term complications.
  • Increased awareness among emergency department physicians can improve early RHS detection.
  • Understanding the varied presentations of RHS is critical for effective patient management.