Significance of surgery to improve speech swallowing in Ramsay Hunt syndrome with high vagus nerve palsy

Abstract

Ramsay Hunt syndrome is characterized by facial nerve palsy, VIIIth cranial nerve symptoms (vertigo, tinnitus, hearing loss), and herpes zoster of the auricle. In addition to the three main features, multiple neurological disorders, such as glossopharyngeal nerve palsy and vagus nerve palsy, are also seen in daily practice, although less frequently. At her previous doctor's office, a 76-year-old woman was diagnosed with left Ramsay Hunt syndrome and was treated with antibiotics and intravenous steroids. She was referred to our department about four months after her initial visit to the previous physician because of residual dysphagia despite rehabilitation. We performed surgery to improve her voice and swallowing due to left high vagus nerve palsy, and the patient had a good outcome. Although the diagnosis of Ramsay Hunt syndrome is relatively easy in daily practice, it is necessary to observe the pharynx thoroughly, as the findings may be overlooked. In addition, the present case suggests that surgery can be a good treatment for patients with residual high vagus nerve palsy and insufficient improvement by rehabilitation.