Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome.
OBJECTIVE
Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome.


METHODS
To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset.


RESULTS
Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy.


CONCLUSIONS
The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome.
Kinishi
M
M
Department of Otorhinolaryngology, Head and Neck Surgery, Kobe University School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe 650-0017, Japan. kinishi@med.kobe-u.ac.jp
Amatsu
M
M
Mohri
M
M
Saito
M
M
Hasegawa
T
T
Hasegawa
S
S
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000255:Adenosine Triphosphate / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003911:Dextrans / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D016697:Herpes Zoster Oticus / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D020127:Recovery of Function; D012720:Severity of Illness Index; D013577:Syndrome; D014805:Vitamin B 12 / Q000627:therapeutic use; D025101:Vitamin B 6 / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D003911:Dextrans; D025101:Vitamin B 6; D000255:Adenosine Triphosphate; D014805:Vitamin B 12; D000212:Acyclovir; D008775:Methylprednisolone