Abstract
Background
The presence of dizziness has been reported as a negative prognostic factor for recovery of facial palsy in Ramsay Hunt syndrome (RHS). The aim of this study was to investigate the incidence and patterns of nystagmus in RHS patients without dizziness, and discuss possible mechanisms. We also compared the severity and prognosis of facial palsy between RHS patients with and without dizziness.
Methods
From January 2014 to January 2019, 36 patients diagnosed with RHS (27 with dizziness and 9 without dizziness) were included. Patterns of nystagmus were examined and categorized using video-nystagmography. House-Brackmann(HB) grade of facial palsy was compared between RHS patients with and without dizziness.
Results
Not only RHS patients with dizziness exhibited nystagmus in most cases (96%, 26 of 27) but also as many as 67% (6 of 9) of RHS patients without dizziness exhibited nystagmus, though the intensity was remarkably weak. In both groups of RHS with and without dizziness, direction-fixed nystagmus and direction-changing positional nystagmus were observed. Initial HB grade and recovery of facial palsy after treatment were not significantly different between RHS with and without dizziness.
Conclusion
Various patterns of nystagmus including direction-fixed and positional direction-changing nystagmus were observed in RHS patients, and inflammation of the vestibular nerve and inner ear end organs may be responsible for the production of nystagmus in these patients. The results support that the evaluation of vestibular function may be necessary even in RHS patients who do not complain of dizziness or vertigo.
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References
Aschan G, Stahle J (1957) Nystagmus in Meniere’s disease during attacks; a nystagmographical study. Acta Otolaryngol 47:189–201
Blackley B, Friedmann I, Wright I (1967) Herpes zoster auris associated with facial nerve palsy and auditory nerve symptoms: a case report with histopathological findings. Acta Otolaryngol 63:533–550
Brandle P, Satoretti-Schefer S, Bohmer A, Wichmann W, Fisch U (1996) Correlation of MRI, clinical, and electroneuronographic findings in acute facial nerve palsy. Am J Otolaryngol 17:154–161
Byun H, Cho YS, Jang JY, Chung KW, Hwang S, Chung WH, Hong SH (2013) Value of electroneurography as a prognostic indicator for recovery in acute severe inflammatory facial paralysis: a prospective study of Bell’s palsy and Ramsay Hunt syndrome. Laryngoscope 123:2526–2532
Choi HR, Choi S, Shin JE, Kim CH (2018) Nystagmus findings and hearing recovery in idiopathic sudden sensorineural hearing loss without dizziness. Otol Neurotol 39:e1084–e1090
Choi JW, Nahm H, Shin JE, Kim CH (2019) Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging. J Neuro-Oncol 25:874–882
Choung YH, Shin YR, Kahng H, Park K, Choi SJ (2006) ‘Bow and lean test’ to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 116:1776–1781
Elliott KJ (1994) Other neurological complications of herpes zoster and their management. Ann Neurol 35(Suppl):S57–S61
Fujiwara Y, Yanagihara N, Kurata T (1990) Middle ear mucosa in Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol 99:359–362
Furuta Y, Fukuda S, Suzuki S, Takasu T, Inuyama Y, Nagashima K (1997) Detection of varicella-zoster virus DNA in patients with acute peripheral facial palsy by the polymerase chain reaction, and its use for early diagnosis of zoster sine herpete. J Med Virol 52:316–319
Hunt JR (1907) On herpetic inflammation of the geniculate ganglion: a new syndrome and its complications. J Nerv Ment Dis 34:73–96
Joshi P, Mossman S, Luis L, Luxon LM (2020) Central mimics of benign paroxysmal positional vertigo: an illustrative case series. Neurol Sci 41:263–269
Kim CH, Choi H, Shin JE (2016) Characteristics of hearing loss in patients with herpes zoster oticus. Medicine 95:e5438
Kim CH, Choi JM, Jung HV, Park HJ, Shin JE (2014) Sudden sensorineural hearing loss with simultaneous positional vertigo showing persistent geotropic direction-changing positional nystagmus. Otol Neurotol 35:1626–1632
Kim CH, Choi JW, Han KJ, Lee YS, Shin JE (2018)Direction-fixed and direction-changing positional nystagmus in Ramsay Hunt syndrome. Otol Neurotol 39:e209–e213
Kim CH, Shin JE, Yang YS, Im D (2016) Sudden sensorineural hearing loss with positional vertigo: initial findings of positional nystagmus and hearing outcomes. Int J Audiol 55:541–546
Kim CH, Shin JE, Yoo MH, Park HJ (2019)Direction-changing and direction-fixed positional nystagmus in patients with vestibular neuritis and Meniere disease. Clin Exp Otorhinolaryngol 12:255–260
Kim CH, Yang YS, Im D, Shin JE (2016) Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis. Acta Otolaryngol 136:559–563
Kim YH, Chang MY, Jung HH, Park YS, Lee SH, Lee JH, Oh SH, Chang SO, Koo JW (2010) Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy. Laryngoscope 120:2270–2276
Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW (2002) Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol 116:844–848
Kumar A (1982) Is spontaneous nystagmus a pathological sign? Laryngoscope 92:618–626
Murakami S, Nakashiro Y, Mizobuchi M, Hato N, Honda N, Gyo K (1998)Varicella-zoster virus distribution in Ramsay Hunt syndrome revealed by polymerase chain reaction. Acta Otolaryngol 118:145–149
Ozdogmus O, Sezen O, Kubilay U, Saka E, Duman U, San T, Cavdar S (2004) Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal. J Anat 205:65–75
Proctor L, Perlman H, Lindsay J, Matz G (1979) Acute vestibular paralysis in herpes zoster oticus. Ann Otol Rhinol Laryngol 88:303–310
Sartoretti-Schefer S, Wichmann W, Valavanis A (1994) Idiopathic, herpetic, and HIV-associated facial nerve palsies: abnormal MR enhancement patterns. AJNR Am J Neuroradiol 15:479–485
Shim HJ, Jung H, Park DC, Lee JH, Yeo SG (2011) Ramsay Hunt syndrome with multicranial nerve involvement. Acta Otolaryngol 131:210–215
Shin DH, Kim BR, Shin JE, Kim CH (2016) Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol 273:1739–1743
Tighilet B, Bordiga P, Cassel R, Chabbert C (2019) Peripheral vestibular plasticity vs central compensation: evidence and questions. J Neurol 266:27–32
Van de Steene V, Kuhweide R, Vlaminck S, Casselman J (2004) Varicella zoster virus: beyond facial paralysis. Acta Otorhinolaryngol Belg 58:61–66
Yeo SW, Lee DH, Jun BC, Chang KH, Park YS (2007) Analysis of prognostic factors in Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 34:159–164
Yi HA, Lee H (2017) Simultaneous occurrence of trigeminal herpes zoster and Ramsay Hunt syndrome presenting sudden prolonged vertigo. Neurol Sci 38:2049–2051
Zajtchuk JT, Matz GJ, Lindsay JR (1972) Temporal bone pathology in herpes oticus. Ann Otol Rhinol Laryngol 81:331–338
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Lee, J., Choi, B., Noh, H. et al. Nystagmus in Ramsay Hunt syndrome with or without dizziness. Neurol Sci 42, 193–198 (2021). https://doi.org/10.1007/s10072-020-04536-w
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DOI: https://doi.org/10.1007/s10072-020-04536-w