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The Ramsay Hunt syndrome is herpes zoster affecting the geniculate ganglion. This syndrome develops when the varicella virus becomes reactivated from the geniculate ganglion. It is seen as a disease of older people but it can affect all ages including children. It usually presents with a paroxysmal attack of deep seated pain in the ear which slowly progresses to be diffuse in nature and continuous type with vesicles, vertigo, facial palsy causing a crooked smile and tinnitus. Making the diagnosis is very difficult when the presentation is simply pain in the ear. It is usually mistaken for Bell's palsy but the presence of vesicles helps in coming to a diagnosis. But in cases of children vesicles may not be present and this could alter the diagnosis. Presence of vertigo may change the diagnosis to acute labyrinthitis. The more severe the damage the longer it will take to recover. Early diagnosis is useful in starting an early treatment of steroids and antiviral agents for the syndrome.
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