Ramsay Hunt Syndrome — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardOral MedicineRamsay Hunt SyndromeORE Part 1

A patient develops acute unilateral lower motor neurone facial weakness, hearing loss and vertigo. Examination shows painful vesicles in the ipsilateral external auditory canal and on the tympanic membrane. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Ramsay Hunt syndrome

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

The diagnosis is **Ramsay Hunt syndrome (A)**: herpes zoster oticus associated with ipsilateral peripheral facial nerve palsy. Painful vesicles in the external auditory canal or on the tympanic membrane are the key discriminator, while hearing loss and vertigo reflect possible eighth-cranial-nerve involvement. **Bell palsy** causes acute peripheral facial weakness but has no herpetic ear eruption. **Ménière disease** can produce episodic vertigo and hearing symptoms, but not facial palsy or vesicles. **Vestibular schwannoma** usually causes slowly progressive unilateral audiovestibular symptoms rather than an acute vesicular illness with facial weakness. **Acute otitis media** may cause otalgia and conductive hearing loss, but does not explain the characteristic vesicles and combined facial/vestibulocochlear neuropathy.

Reference: Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. Journal of Neurology, Neurosurgery & Psychiatry. 2001;71:149–154. https://pubmed.ncbi.nlm.nih.gov/11459884/