Ramsay Hunt syndrome is an uncommon disorder caused by varicella zoster virus (VZV; the cause of chickenpox, also termed herpes zoster). Viral infection of the geniculate ganglion within the temporal bone principally gives rise to vesiculation and ulceration of the external ear and ipselateral anterior two-thirds of the tongue and soft palate, as well as a lower motor neuron palsy of the facial nerve. Because of its rarity, few studies of any design have investigated the most appropriate means of resolving the signs and symptoms of this disorder. Indeed, the present review found only one RCT that evaluated the efficacy of antiviral therapy (with or without corticosteroids) for Ramsay Hunt syndrome.

This report concludes that intravenous aciclovir plus corticosteroids is no more effective than corticosteroids alone in promoting facial nerve recovery at 6 months after onset of disease. As might be expected, the authors conclude that high-quality, appropriately powered RCT are required, and suggest a number of sensible outcomes.

There are increasing numbers of agents available for the treatment of VZV, so any future studies of this rare disorder should take account of current literature detailing their efficacy in the management of VZV. Unless vaccination policies for VZV become widespread there will always be a risk of occasional adults developing Ramsay Hunt syndrome, so there is a clinical need for rigorous studies of therapy. The low prevalence of Ramsay Hunt syndrome means that any future RCT will need to be multicentred in order to obtain the numbers of patients required for a conclusive study. Although these studies will be logistically difficult and expensive, they should provide guidance over the most appropriate means of resolving what is an alarming disorder for affected individuals.