What criteria should I use to determine if a patient with Ramsay Hunt Syndrome requires referral to a specialist?

Referral criteria for a patient with Ramsay Hunt Syndrome (RHS) to a specialist include:

• Presence of facial weakness or paralysis: RHS typically involves facial nerve palsy, so any new or worsening facial weakness should prompt referral for specialist neurological or ENT assessment.
• Sudden onset or rapidly progressive symptoms: Rapid progression of neurological symptoms such as facial weakness or hearing loss requires urgent specialist evaluation.
• Hearing loss or vestibular symptoms: Sudden or rapidly worsening hearing loss or vestibular symptoms (e.g., vertigo) not explained by benign causes should be referred urgently to ENT or audiovestibular medicine services.
• Additional neurological signs: Presence of other neurological deficits (e.g., altered sensation, facial numbness, or abnormal neurological signs) warrants urgent referral for neuroimaging and specialist assessment.
• Failure to respond to initial treatment or complications: If symptoms are refractory or complications arise, specialist input is needed.

These criteria align with NICE recommendations for referral in suspected neurological conditions and hearing loss, emphasizing urgent referral for sudden facial weakness, hearing loss, or additional neurological signs to appropriate specialist services NICE NG127,NICE NG98.