B-ENT, 2019, 15, 297-302 Introduction In 1907, Ramsay Hunt syndrome (RHS) was frst described by James Ramsay Hunt. 1 About 12% of cases of peripheral facial palsy (FP) are associated with RHS, which is characterized by acute FP, otalgia, and the presence of erythematous vesicular rashes in the external auditory canal and pinna. 1,2 The RHS should be distinguished from RHS sine herpete, which can occur without ear rush, 3 and from herpes zoster oticus, which presents without FP. 4 Occasionally, RHS can be accompanied by other cranial nerve dysfunctions, such as cochleovestibular symptoms, dysgeusia, or facial numbness. 2 Following the primary infection, the varicella- zoster virus (VZV) becomes latent in the cells of the dorsal root ganglia and may be reactivated after a period of several decades; the otic involvement occurs in the geniculate, auditory, and vestibular ganglia. 5 There are several risk factors that can contribute to VZV reactivation, such as upper respiratory tract infection, emotional stress, aging, smoking, diabetes, depression, cancer, immuno- suppressive therapy, and chronic renal failure. 3,6 The aim of this study was to investigate the clinical manifestations of RHS in order to better achieve an accurate diagnosis and initiate the appropriate treatment. In addition, we analyzed statistically signifcant correlations between clinical data and the level of fnal facial function to determine prognostic factors for patients. Materials and methods We retrospectively reviewed the clinical data of 52 patients diagnosed with RHS in our center between 2012 and 2017. The House-Brackmann (HB) grading system was used to evaluate the initial presentation, the time of improvement, and the fnal facial function. The recovery of facial function was categorized as: full recovery with HB I, satisfactory outcome with HB II, and poor recovery with HB V to VI. The extent of herpetic vesicles on the pinna, external ear canal, face, oral cavity, lips, or cervical region were also recorded, as well as the time of vesicle eruption before (or the same day) and after the FP onset. The following clinical data were analyzed statistically to identify correlations with the fnal HB grade: clinical symptoms including Ramsay Hunt syndrome: clinical presentation and prognostic factors G. Psillas, S. Dova, F. Ieridou, A. Kyrgidis, J. Constantinidis Department of Otorhinolaryngology and Head & Neck Surgery, AHEPA Hospital, Thessaloniki, Greece Key-words: Facial palsy; Ramsay Hunt syndrome; prognosis; headache; nystagmus; hearing loss Abstract. Objective: Ramsay Hunt Syndrome (RHS) is a peripheral facial nerve palsy (FP) associated with otalgia and vesicular eruptions on the external ear. This study aimed to evaluate the clinical features of RHS and determine the prognostic factors. Materials and methods: This was a retrospective study, which included 52 patients with RHS who underwent combined steroid and antiviral treatment. The House-Brackmann (HB) grading system was used for the initial presentation and fnal outcome, as follows: full recovery (HB I), satisfactory outcome (HB II), and poor recovery (HB V and VI). The associated clinical symptoms, side of FP, delay of treatment, time of initial facial function improvement, comorbid diseases, time of vesicle eruption, audiogram testing, initial nerve excitability test (NET), and electroneurography (ENoG) were evaluated to identify correlations with the fnal HB grade. Results: At presentation, more than half (55%) the RHS patients were HB V and VI. Full recovery was achieved in 19 (36.5%) patients, there was a satisfactory outcome in 23 (44.2%), and poor recovery in 2 (3.8%). The most common symptoms were headache of the temporal area (57.6%) and imbalance (44.2%). The initial NET threshold and percentage degeneration on ENoG most signifcantly correlated with the fnal HB grade. Conclusions: Headache in the temporal area and imbalance were the most common symptoms of RHS; while, the NET and ENoG were the most important prognostic factors. In the early phase, a lack of response on the NET and an increased percentage of degeneration on ENoG were clinically correlated with poor outcome. 07-Psillas.indd 297 07-Psillas.indd 297 16/12/2019 10:51 16/12/2019 10:51