Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults.
BACKGROUND
Herpes zoster oticus (HZO) is a viral infection of the ear and when associated with acute facial paralysis is known as Ramsay Hunt syndrome. Antiviral agents are the standard first-line treatment for herpes zoster infections at other body sites and are thought to reduce or minimise nerve damage, thereby improving outcomes. It has been suggested that these agents improve the chance of facial weakness improving or resolving completely in patients with Ramsay Hunt syndrome.


OBJECTIVE
To determine the effectiveness of antiviral agents in the treatment of adult patients with Ramsay Hunt syndrome (HZO with facial palsy).


METHODS
We searched the Cochrane ENT Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, current issue), Medline (1950 - 2007), PubMed 2007 - 2008, EMBASE (1974 onwards) and other relevant databases. The date of the most recent search was June 2008.


METHODS
Two authors scrutinized all possible citations to identify randomised controlled trials in which antiviral agents alone or in combination with other therapies (using different routes of administration and dosage schemes) were given as treatment for Ramsay Hunt syndrome. We contacted an author for further information.


METHODS
Two reviewers independently assessed eligibility and trial quality.


RESULTS
Only one randomised, controlled trial was identified and included. It was of low quality and included only 15 participants. In this 1992 trial, intravenous acyclovir and corticosteroids were compared with corticosteroids alone. Our analysis found no statistically significant difference between the two groups.


CONCLUSIONS
We found no evidence that anti-viral agents have a beneficial effect on outcomes in Ramsay Hunt syndrome, despite their widespread use in this condition. The use of these drugs in patients with herpes zoster infections in other parts of the body might suggest that they have a role in herpes zoster oticus. As usual, the absence of positive evidence of benefit (or, in this case, the 'negative' result of one small, statistically under-powered study) does not necessarily indicate that antivirals are ineffective. However, these drugs are associated with a number of adverse effects and this must be taken into consideration when undertaking the requisite risk-benefit analysis before instigating treatment.
A&E Department, Basildon and Thurrock University Hospital, Nethermayne, Basildon, Essex, UK, SS16 5NL. tere_u@yahoo.com
Teresa
T
Uscategui
Carolyn
C
Dorée
Ian J
IJ
Chamberlain
Martin J
MJ
Burton
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005158:Facial Paralysis / Q000188:drug therapy*; D016697:Herpes Zoster Oticus / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome
D000998:Antiviral Agents