It has been reported that delayed facial nerve palsy could sometimes occur after otologic surgery. We encountered a case of delayed onset of Ramsay Hunt syndrome after cochlear implantation.
The patient was a 71-year-old woman who began wearing hearing aids at the age of 69 for bilateral hearing loss. She then visited our department for cochlear implantation. Cochlear implantation was performed in a routine manner, and was completed without exposure of the facial nerve or chorda tympani. The insertion of the electrodes was smooth. After left cochlear implantation, the patient had good hearing. However, 12 days after the surgery, she presented with dizziness, auricular herpes zoster, and facial nerve palsy. The serum titer of varicella zoster virus (VZV) IgG was significantly high and the patient was diagnosed as showing VZV reactivation. She did not improve with the usual medications or to ENoG, and facial nerve decompression was performed; we used the TEES approach for the facial decompression in consideration of the effect on the inserted electrodes. Facial nerve decompression via the TEES approach is considered to be useful for decompressing at the horizontal portion of the facial nerve. The facial nerve palsy is slowly improving, and we are continuing to monitor the patient’s progress.
We think that careful follow-up after otologic surgery is necessary, keeping in mind the possibility of development of delayed facial nerve palsy and Ramsay Hunt syndrome.
