Ramsay Hunt sendromunda kombine tedavi: Klinik ve prognozun değerlendirilmesi

Amaç: Çalışmanın amacı Ramsay Hunt sendromu tanısı alan hastaların klinik özelliklerini, tedavi ve sonuçlarını retrospektif olarak analiz etmektir. Yöntem: Ramsay Hunt sendromlu 12 hasta retrospektif olarak analiz edildi. Hastaların cinsiyeti, yaşı, tedaviye ilk başvuru süresi ve klinik sonuçları kaydedildi. Fasiyal disfonksiyonun değerlendirilmesinde House-Brackmann evreleme sistemi kullanıldı. Bütün hastalar oral steroid ve acyclovir ile tedavi edildi. Bulgular: Hastalarımızın 7'si erkek, 5'i kadın idi. Hastalarımızın yaş ortalaması 59 olarak bulundu (21-68 arası). En önemli semptom akut fasiyal paralizi idi. Hastaların tedavi öncesi House-Brackmann skalası III ile VI arasında değişmekteydi. Tüm hastalarda ilk ortalama House-Brackmann skalası değeri 4.5, tedavi sonrası 2.33 idi. House Brackmann skalası V ve VI olan hastalarda fasiyal paralizinin dönme riski daha düşüktü. Sonuç: Ramsay Hunt sendromunda, fasiyal paralizinin prognozu ilk semptomlara ve klinik bulgulara bağlıdır. Prognoz ciddi paralizi ve komorbid hastalığı olanlarda daha kötüdür.

Combined treatment in Ramsay Hunt syndrome: evaluation of clinic and prognosis

Objective: We retrospectively analysed clinical characteristics, treatment and outcomes of the patients with Ramsay Hunt syndrome. Methods: Twelve patients with Ramsay Hunt syndrome were analysed retrospectively. Data recorded included sex, age, time from first onset to initial treatment and clinical outcomes. The House-Brackmann scale was used to assess initial facial nerve dysfunction and final facial nerve impairment. All patients were treated with oral steroids and oral acyclovir. Results: There were 7 male and 5 female patients. Mean age was 59 (range: 21 to 68) years. The main symptom was acute facial palsy. House-Brackmann classification of facial nerve function ranged from grade III to VI before treatment. The median baseline House-Brackmann grade was 4.5 and it was 2.33 after the treatment in all patients. Recovery rate of facial palsy was lower in patients with House-Brackmann grades V and VI. Conclusion: In this syndrome, the prognosis of facial palsy depends on the initial symptoms and clinical findings. The prognosis was poorer in severe palsy and patients with comorbid disease(s).

___

  • Robillard RB, Hilsinger RL, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 1986:95;292–7.
  • Adour KK. Otologic complications of herpes zoster. Ann Neurol 1994;35:62–4.
  • Kansu L, Yilmaz I. Herpes zoster oticus (Ramsay Hunt syn- drome) in children: case report and literature review. Int J Ped Otorhinolaryngol 2012:76;772–6.
  • Ko JY, Sheen TS, Hsu MM. Herpes zoster oticus treated with acyclovir and prednisolone: clinical manifestations and analysis of prognostic factors. Clin Otolaryngol Allied Sci 2000;25:139–42.
  • Wagner G, Klinge H, Max Sachse M. Ramsay Hunt syndrome. J Dtsch Dermatol Ges 2012;10:238–43.
  • Kinishi M, Amatsu M, Mohri M, Saito M, Hasegawa T, Hasegawa S. Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome. Auris Nasus Larynx 2001;28:223–6.
  • Uscategui T, Doree C, Chamberlain IJ,Burton MJ. Antiviral ther- apy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 2008;8(4): CD006851.
  • Lee DH, Chae SY, Park YS, Yeo SW. Prognostic value of elec- troneurography in Bell’s palsy and Ramsay-Hunt’s syndrome. Clin Otolaryngol 2006;31:144–8.
  • Zainine R, Sellami M, Charfeddine A, Beltaief N, Sahtout S, Besbes G. Ramsay Hunt syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:22–5.
  • Coulson S, Croxson GR, Adams R, Oey V. Prognostic factors in herpes zoster oticus (Ramsay Hunt syndrome). Otol Neurotol 201;32:1025–30.
  • Yeo SW, Lee DH, Jun BC, Chang KH, Park YS. Analysis of prog- nostic factors in Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 2007;34:159–64.
  • Anpalahan V, Redhead J. Acyclovir and prednisolone combination treatment in Bell’s palsy. Aust J Otolaryngol 2000;3:476–8.
  • Byun H, Cho YS, Jang JY, Chung KW, Hwang S, Chung WH, Hong SH. 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 2013;123:2526–32.
  • Morishima N, Yagi R, Shimizu K, Ota S. Prognostic factors of synkinesis after Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 2013;40:431–4.
  • This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
  • NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
  • tion in any medium, provided the original work is properly cited.
  • Please cite this article as: Pınar E, ‹mre A, Olgun Y, Ece AA, Songu M, Aslan H. Combined treatment in Ramsay Hunt syndrome: evaluation of clinic and
  • prognosis. J Med Updates 2014;4(3):110–112.
ENT Updates-Cover
  • ISSN: 2149-7109
  • Başlangıç: 2015
  • Yayıncı: Prof.Dr.Murat Demir