Vocal cord paralysis associated with Ramsay Hunt syndrome: looking back 50 years

Abstract

Ramsay Hunt syndrome is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis. Vocal cord paralysis is more often seen as a symptom of various other diseases, that is, malignant tumours, neurodegenerative illness, cerebrovascular assaults, inflammatory processes or as a result of intubation or surgical procedures. The symptoms of unilateral vocal cord paralysis are mainly hoarseness, dyspnoea and dysphagia. We present a case of Ramsay Hunt syndrome combined with unilateral hearing loss and left vocal cord paralysis. The patient underwent MRI, CT and a lumbar puncture causing anxiety in the patient and delaying the initiation of antiviral and anti-inflammatory treatment, which is only efficient when initiated within 72 h. We hope to raise the awareness of this disease.

Figure 1

Multi-Dimensional Voice Programme radial graphic display of a patient with recurrent nerve palsy showing breathy function and instability in the voice, with increased perturbation values and elevated amplitude values (above threshold level in the lower right quarter of the radial graph) as well as a small increase in tremor values (SPI/ATRI).