Do antiviral agents effectively treat Ramsay Hunt syndrome?

The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase and other relevant databases (Cinhal.LILACS,KoreaMed, IndMed, PakMediNet, theUK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), Google Scholar, NLH ENT & Audiology Specialist Library and the metaRegister of Controlled Trials (mRCT).) were utilised to identify possible trials.

Randomised controlled trials (RCT) were eligible for inclusion if antiviral agents alone or in combination with other therapies (using different routes of administration and dosage schemes) had been taken as treatment for Ramsay Hunt syndrome.

Two reviewers independently assessed eligibility and trial quality.

Only one RCT was identified and included. It was of low quality and included only 15 participants. In this 1992 trial, treatment with intravenous aciclovir and corticosteroids was compared with corticosteroids alone. Analysis found no statistically significant difference between the two groups.

The use of antiviral agents against herpes zoster infections in other parts of the body suggests that they could be useful in the case of herpes zoster oticus. We found no evidence that they have a beneficial effect on outcomes in Ramsay Hunt syndrome, despite their widespread use in this condition. As usual, however, the absence of positive evidence of benefit (or, in this case, the 'negative' result of one small, statistically underpowered study) does not necessarily indicate that antivirals are ineffective. The results of the review do suggest that the various adverse effects of antivirals should be taken into consideration in the risk-benefit analysis that foregoes treatment.