Prognostic factors in herpes zoster oticus (ramsay hunt syndrome)

Objectives: To determine if an accurate prognosis can be made in patients with Herpes zoster oticus (HZO), facial nerve outcomes were assessed at 1-year after onset and compared with symptoms and signs at presentation.
Study design: Individual retrospective cohort study of 101 records in a case series (level of evidence: Level 2b).
Methods: Symptoms, signs, audiology, and treatment records were analyzed to determine their association with facial nerve outcome at 1 year.
Results: Mean improvement at 1 year for the 101 patients was 3 House-Brackmann (HB) grade units. Initially, severity ranged from HB III to HB VI. Mean recovery was significantly greater for those patients who were initially more affected, although at 1 year, they had still not recovered to the same grade as those initially less affected. Having both incomplete eye closure and a dry eye was associated with less recovery at 1 year. The use of prednisone combined with an antiviral agent, and begun at or after Day 5 of the illness, was related to a better facial nerve outcome. No other symptom, sign, or audiologic feature was of prognostic value.
Conclusion: All patients with HZO improved facial function to some degree, with the mean gain at 1 year after onset being 3 HB grade units. Improvement was less for patients who initially had both incomplete eye closure and dry eye. The group who received a combination of an antiviral medication with steroids given after 5 days had the best facial nerve outcome.