title: Autoimmune recurrent facial palsy and bilateral sudden sensorineural hearing loss following Ramsay Hunt-like syndrome.
abstract: OBJECTIVE
  To describe the first published case of recurrent facial nerve palsy associated with bilateral sudden sensorineural hearing loss of autoimmune origin.
  
  
  METHODS
  A 33-year-old male presented with acute facial palsy on the left following a vesicular herpetic eruption in the external ear canal on the same side. Serologic measurements demonstrated an elevation of IgM antibodies against herpes simplex virus but not for varicella-zoster virus, confirming a Ramsay Hunt-like syndrome due to herpes simplex virus. The following four months, the patient exhibited other three episodes of facial palsy, well responded to steroid treatment. During the clinical course, a sudden sensorineural hearing loss was also diagnosed, initially on the left side and then on both sides. The autoimmune markers such as the antinuclear antibody and the anti-gangliosides antibodies (anti-GM1, anti-GQ1b) were found positive. Despite steroid treatment, hearing did not show any improvement, remaining moderate on the right and severe on the left.
  
  
  CONCLUSIONS
  Recurrent facial nerve palsy and bilateral sudden sensorineural hearing loss could be the expression of autoimmune disturbances. The initial triggered factor could be the herpes simplex virus infection, such as a Ramsay Hunt-like syndrome.
authors.affiliation: 1st Academic ENT Department, American Hellenic Educational Progressive Association Hospital, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi St., Thessaloniki, Greece. psill@otenet.g
authors.forename: George
authors.initials: G
authors.lastname: Psillas
authors.forename: Marianthi
authors.initials: M
authors.lastname: Arnaoutoglou
authors.forename: Trifonas
authors.initials: T
authors.lastname: Gatsios
authors.forename: Dimitris
authors.initials: D
authors.lastname: Rizos
authors.forename: Efrosini
authors.initials: E
authors.lastname: Koutsouraki
authors.forename: Victor
authors.initials: V
authors.lastname: Vital
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use; D005158:Facial Paralysis / Q000175:diagnosis* / Q000188:drug therapy; D006312:Hearing Loss, Bilateral / Q000175:diagnosis* / Q000188:drug therapy; D003639:Hearing Loss, Sudden / Q000175:diagnosis* / Q000188:drug therapy; D016697:Herpes Zoster Oticus / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D012008:Recurrence; D018139:Simplexvirus; D014775:Virus Activation
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D001323:Autoantibodies; D003907:Dexamethasone; D000212:Acyclovir