[Dysphagia] Ramsay Hunt syndrome

[eripley at yahoo.com (Irene Campbell-Taylor)]

I wonder if, given the description, this may not be Collet Sicard syndrome, affecting IX, X, IX and XII.  Is tongue function truly intact and had IX been tested? This syndrome is also often the result of herpes zoster encephalitis. If it is Ramsay-Hunt, when damage to the nerves is minimal,  a full recovery is usually expected within a few weeks. If damage is severe, there may not be full recovery even after several months. Overall, chances of recovery are better (70%)  if treatment is started 3 days after the onset of symptoms. If treatment is delayed more than 3 days, the chances of complete recovery drop to about 50%.. Recovery may be complicated if the nerve grows back to the wrong areas (synkinesis) which may cause inappropriate responses, such as tears when laughing or chewing (crocodile tear syndrome, Frey syndrome). Some other people may experience blinking of the eye when talking or eating. There may also be long term damage in hearing as full recovery only occurs
 in 50% of patients and residual tinnitus is common. Vertigo can continue for months but often leaves after only a few weeks. The initial onset of vertigo can produce severe nausea and vomiting in cases but prolonged effects are rare.

Alicia Multari <MULTARIA at nychhc.org> wrote:  71yom a/w difficulty swallowing, voice change/hoarseness for 3 days with right facial weakness. ENT w/u revealed right vocal cord paralysis, neurological workup was negative for acute pathology. Neurology confirmed Ramsay Hunt syndrome via CSF detection of VZV. Patient w/ obvious CN IX, X impairement. Swallow instrumentation revealed moderate pooling w/ penetration and silent aspiration, a right head turn w/ effortful swallow and chin tuck appeared to resolve some of the pooling. 

Patient is now being treated w/ acyclovir IV (day #2). Voice is still hoarse and breathy. 


My question : Any comments re: how long will it take for symptoms to resolve? do they resolve? any experience w/ this type of patient? 

Thanks in advance

Alicia Multari, M.S., CCC-SLP
Speech Language Pathologist
Elmhurst Hospital Center
79-01 Broadway
Elmhurst, NY 11373

718 334-3398 (office)
718 334-3909 (fax)

-----------------------------------------
Visit www.nyc.gov/hhc

CONFIDENTIALITY NOTICE: The information in this E-Mail may be
confidential and may be legally privileged. It is intended solely
for the addressee(s). If you are not the intended recipient, any
disclosure, copying, distribution or any action taken or omitted to
be taken in reliance on this e-mail, is prohibited and may be
unlawful. If you have received this E-Mail message in error, notify
the sender by reply E-Mail and delete the message.



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com