A Rare Cause of Facial Paralysis in Children: A Case of Ramsay Hunt Syndrome

Abstract

Peripheral facial paralysis in children can have many causes including trauma, otitis media, head and neck tumors, congenital anomalies, viral infections, as well as metabolic and genetic factors. One cause of peripheral facial paralysis is Ramsay Hunt syndrome (RHS), which is also known as herpes zoster oticus, affecting the seventh and eighth cranial nerves. It is characterized by inner ear dysfunction, periauricular pain, and peripheral facial paralysis accompanied by the presence of an erythematous vesicular rash around the ear pinna and outer ear canal or in the oral mucosa. RHS is very rare in children when compared with its prevalence in adults. A 13-year-old male with no prior medical history applied to the pediatric emergency department after having first developed a vesicular rash on the left ear pinna and pain around the left ear, which was followed 1 day later by the development of ipsilateral facial asymmetry. The patient was hospitalized and simultaneously started on 2 mg/kg/d methylprednisolone for 10 days (followed by a 15-day taper), 100 mg/kg/d intravenous ceftriaxone twice per day (stopped on day 10), 30 mg/kg/d intravenous acyclovir three times per day (stopped on day 21), ciprofloxacin ear drops, tobramycin eye drops, ointment, and artificial tear drops with eye patching. However, only a minimal improvement was observed in the patient's peripheral facial paralysis by day 21. When compared with the prevalence in adults, RHS is very rare in children, which is why reports of pediatric RHS are limited in the literature. Therefore, additional studies are needed to provide information about the pathophysiology, diagnosis, and treatment of pediatric RHS.