Facial-Stapedial Synkinesis Following Ramsay Hunt Syndrome: A Case Report

We report the first documented case of facial-stapedial synkinesis (FSS) secondary to Ramsay Hunt syndrome (RHS) by describing the clinical manifestations and definitive surgical treatment outcome of this rare condition. A 35-year-old female presented with initial symptoms of severe right-sided facial weakness, otalgia, hyperacusis, ear fullness, and erythematous vesicles in the external auditory canal and tympanic membrane, suggestive of RHS. She later developed an intermittent "quivering" or "buzzing" sensation in her right ear initiated by facial movements such as closing her eyes and smiling. We performed magnetic resonance imaging of the brain and serial audiometric testing, and administered pharmacological treatment, including prednisone and famciclovir, for the initial infection, followed by stapedial tendon tenotomy for the definitive management of FSS. This case provides valuable clinical insights as the first reported instance of FSS secondary to RHS. RHS causes a more severe facial paralysis with lower rates of complete recovery, with an increased risk of aberrant facial nerve regeneration. FSS should be considered in patients presenting with persistent auditory symptoms after facial paralysis. Stapedial tendon tenotomy is an effective treatment option for patients with severe refractory symptoms.