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Martin J Burton - One of the best experts on this subject based on the ideXlab platform.
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antiviral therapy for ramsay hunt syndrome Herpes Zoster Oticus with facial palsy in adults
Cochrane Database of Systematic Reviews, 2008Co-Authors: Teresa Uscategui, Ian J Chamberlain, Carolyn Doree, Martin J BurtonAbstract:Background Herpes Zoster Oticus (HZO) is a viral infection of the ear and when associated with acute facial paralysis is known as Ramsay Hunt syndrome. Antiviral agents are the standard first-line treatment for Herpes Zoster infections at other body sites and are thought to reduce or minimise nerve damage, thereby improving outcomes. It has been suggested that these agents improve the chance of facial weakness improving or resolving completely in patients with Ramsay Hunt syndrome. Objectives To determine the effectiveness of antiviral agents in the treatment of adult patients with Ramsay Hunt syndrome (HZO with facial palsy). Search methods We searched the Cochrane ENT Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, current issue), Medline (1950 - 2007), PubMed 2007 - 2008, EMBASE (1974 onwards) and other relevant databases. The date of the most recent search was June 2008. Selection criteria Two authors scrutinized all possible citations to identify randomised controlled trials in which antiviral agents alone or in combination with other therapies (using different routes of administration and dosage schemes) were given as treatment for Ramsay Hunt syndrome. We contacted an author for further information. Data collection and analysis Two reviewers independently assessed eligibility and trial quality. Main results Only one randomised, controlled trial was identified and included. It was of low quality and included only 15 participants. In this 1992 trial, intravenous acyclovir and corticosteroids were compared with corticosteroids alone. Our analysis found no statistically significant difference between the two groups. Authors' conclusions We found no evidence that anti-viral agents have a beneficial effect on outcomes in Ramsay Hunt syndrome, despite their widespread use in this condition. The use of these drugs in patients with Herpes Zoster infections in other parts of the body might suggest that they have a role in Herpes Zoster Oticus. As usual, the absence of positive evidence of benefit (or, in this case, the 'negative' result of one small, statistically under-powered study) does not necessarily indicate that antivirals are ineffective. However, these drugs are associated with a number of adverse effects and this must be taken into consideration when undertaking the requisite risk-benefit analysis before instigating treatment.
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corticosteroids as adjuvant to antiviral treatment in ramsay hunt syndrome Herpes Zoster Oticus with facial palsy in adults
Cochrane Database of Systematic Reviews, 2008Co-Authors: Teresa Uscategui, Ian J Chamberlain, Carolyn Doree, Martin J BurtonAbstract:Background Inflammation and oedema of the facial nerve due to viral infection by the Herpes Zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (Herpes Zoster Oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to play in the reduction or minimisation of nerve damage when administered together with antiviral therapy, and therefore may improve the outcome for patients with Ramsay Hunt syndrome. Objectives To determine the effectiveness of corticosteroids as an adjuvant to antiviral therapy in adult patients with Ramsay Hunt syndrome (Herpes Zoster Oticus with facial palsy). Search methods We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 4, 2007), MEDLINE (1950 to December 2007) and EMBASE (1974 to December 2007), CINAHL (1982 to December 2007), LILACS, KoreaMed, IndMed, PakMediNet, ZETOC, Cambridge Scientific Abstracts (Conference Proceedings Database), ISI Proceedings (Web of Science), the National Research Register (NRR), the UK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Research Findings Register (ReFeR) and the metaRegister of Controlled Trials (mRCT). Selection criteria All randomised controlled trials in which corticosteroids (by any route of administration at any dosage) were given as an adjuvant to antiviral agents in the treatment of Ramsay Hunt syndrome. Data collection and analysis Two reviewers independently assessed eligibility and trial quality of the available studies, whether they were published or unpublished. No trials were found and therefore no data were analysed. Main results This is an empty review as no trials were found that fulfilled the inclusion criteria. Authors' conclusions Since no randomised controlled trials investigating the use of corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome were identified, such studies are needed to assess the effects of such therapy.
Amit Goyal - One of the best experts on this subject based on the ideXlab platform.
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bilateral ramsay hunt syndrome in a diabetic patient
BMC Ear Nose and Throat Disorders, 2004Co-Authors: Rajan Syal, Isha Tyagi, Amit GoyalAbstract:Background Herpes Zoster Oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral Herpes Zoster Oticus can sometime occur in immunocompromised patients, though incidence is very rare.
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Bilateral Ramsay Hunt syndrome in a diabetic patient
BMC Ear Nose and Throat Disorders, 2004Co-Authors: Rajan Syal, Isha Tyagi, Amit GoyalAbstract:Background Herpes Zoster Oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral Herpes Zoster Oticus can sometime occur in immunocompromised patients, though incidence is very rare. Case presentation Diabetic male, 57 year old presented to us with bilateral facial palsy due to Herpes Zoster Oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. Conclusions Herpes Zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes Zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients.
Teresa Uscategui - One of the best experts on this subject based on the ideXlab platform.
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antiviral therapy for ramsay hunt syndrome Herpes Zoster Oticus with facial palsy in adults
Cochrane Database of Systematic Reviews, 2008Co-Authors: Teresa Uscategui, Ian J Chamberlain, Carolyn Doree, Martin J BurtonAbstract:Background Herpes Zoster Oticus (HZO) is a viral infection of the ear and when associated with acute facial paralysis is known as Ramsay Hunt syndrome. Antiviral agents are the standard first-line treatment for Herpes Zoster infections at other body sites and are thought to reduce or minimise nerve damage, thereby improving outcomes. It has been suggested that these agents improve the chance of facial weakness improving or resolving completely in patients with Ramsay Hunt syndrome. Objectives To determine the effectiveness of antiviral agents in the treatment of adult patients with Ramsay Hunt syndrome (HZO with facial palsy). Search methods We searched the Cochrane ENT Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, current issue), Medline (1950 - 2007), PubMed 2007 - 2008, EMBASE (1974 onwards) and other relevant databases. The date of the most recent search was June 2008. Selection criteria Two authors scrutinized all possible citations to identify randomised controlled trials in which antiviral agents alone or in combination with other therapies (using different routes of administration and dosage schemes) were given as treatment for Ramsay Hunt syndrome. We contacted an author for further information. Data collection and analysis Two reviewers independently assessed eligibility and trial quality. Main results Only one randomised, controlled trial was identified and included. It was of low quality and included only 15 participants. In this 1992 trial, intravenous acyclovir and corticosteroids were compared with corticosteroids alone. Our analysis found no statistically significant difference between the two groups. Authors' conclusions We found no evidence that anti-viral agents have a beneficial effect on outcomes in Ramsay Hunt syndrome, despite their widespread use in this condition. The use of these drugs in patients with Herpes Zoster infections in other parts of the body might suggest that they have a role in Herpes Zoster Oticus. As usual, the absence of positive evidence of benefit (or, in this case, the 'negative' result of one small, statistically under-powered study) does not necessarily indicate that antivirals are ineffective. However, these drugs are associated with a number of adverse effects and this must be taken into consideration when undertaking the requisite risk-benefit analysis before instigating treatment.
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corticosteroids as adjuvant to antiviral treatment in ramsay hunt syndrome Herpes Zoster Oticus with facial palsy in adults
Cochrane Database of Systematic Reviews, 2008Co-Authors: Teresa Uscategui, Ian J Chamberlain, Carolyn Doree, Martin J BurtonAbstract:Background Inflammation and oedema of the facial nerve due to viral infection by the Herpes Zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (Herpes Zoster Oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to play in the reduction or minimisation of nerve damage when administered together with antiviral therapy, and therefore may improve the outcome for patients with Ramsay Hunt syndrome. Objectives To determine the effectiveness of corticosteroids as an adjuvant to antiviral therapy in adult patients with Ramsay Hunt syndrome (Herpes Zoster Oticus with facial palsy). Search methods We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 4, 2007), MEDLINE (1950 to December 2007) and EMBASE (1974 to December 2007), CINAHL (1982 to December 2007), LILACS, KoreaMed, IndMed, PakMediNet, ZETOC, Cambridge Scientific Abstracts (Conference Proceedings Database), ISI Proceedings (Web of Science), the National Research Register (NRR), the UK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Research Findings Register (ReFeR) and the metaRegister of Controlled Trials (mRCT). Selection criteria All randomised controlled trials in which corticosteroids (by any route of administration at any dosage) were given as an adjuvant to antiviral agents in the treatment of Ramsay Hunt syndrome. Data collection and analysis Two reviewers independently assessed eligibility and trial quality of the available studies, whether they were published or unpublished. No trials were found and therefore no data were analysed. Main results This is an empty review as no trials were found that fulfilled the inclusion criteria. Authors' conclusions Since no randomised controlled trials investigating the use of corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome were identified, such studies are needed to assess the effects of such therapy.
Phillip A Wackym - One of the best experts on this subject based on the ideXlab platform.
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Molecular Temporal Bone Pathology: II. Ramsay Hunt Syndrome (Herpes Zoster Oticus)
Laryngoscope, 1997Co-Authors: Phillip A WackymAbstract:In 1907 J. Ramsay Hunt suggested that Herpes Zoster Oticus resulted from a geniculate ganglionitis ; however, many contemporary authors believe that this disorder represents a neuritis or polycranial neuropathy. Herpes varicella-Zoster viral (VZV) DNA was identified, using the polymerase chain reaction, in archival celloidin-embedded temporal bone sections from two patients who clinically had Ramsay Hunt syndrome (Herpes Zoster Oticus). The presence of VZV was confirmed by sequencing the PCR products. These experiments demonstrated that VZV genomic DNA was present in the geniculate ganglion of the side with facial paralysis and cutaneous recrudescence in both patients and in the clinically unaffected side in patient 1. In addition, patient 2 had a sudden hearing loss and was found to have VZV genomic DNA in sections from the affected side containing the spiral ganglion, Scarpa's ganglion, organ of Corti, and macula of the saccule. No VZV genomic DNA was identified in temporal bone sections from five patients with Bell's palsy and ten patients without evidence of otologic disease. In this study, the histopathology of these two cases yielded complementary information regarding the role of VZV in Herpes Zoster Oticus. These data suggest that in patients with Ramsay Hunt syndrome, latent VZV is located in the geniculate ganglia and may be present in the auditory and vestibular primary afferent ganglia in some patients.
Rajan Syal - One of the best experts on this subject based on the ideXlab platform.
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bilateral ramsay hunt syndrome in a diabetic patient
BMC Ear Nose and Throat Disorders, 2004Co-Authors: Rajan Syal, Isha Tyagi, Amit GoyalAbstract:Background Herpes Zoster Oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral Herpes Zoster Oticus can sometime occur in immunocompromised patients, though incidence is very rare.
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Bilateral Ramsay Hunt syndrome in a diabetic patient
BMC Ear Nose and Throat Disorders, 2004Co-Authors: Rajan Syal, Isha Tyagi, Amit GoyalAbstract:Background Herpes Zoster Oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral Herpes Zoster Oticus can sometime occur in immunocompromised patients, though incidence is very rare. Case presentation Diabetic male, 57 year old presented to us with bilateral facial palsy due to Herpes Zoster Oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. Conclusions Herpes Zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes Zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients.