Patient presents with asymmetric corners of mouth, inability to close the eye, disappearance of nasolabial fold and loss of wrinkling of forehead.The patient also presents with hyperacusis, loss of taste in anterior two thirds of tongue, loss of lacrimation, and lesions on the ear. What is the diagnosis and what nerve is affected and in which level is it affected?

Ans: Ramsay Hunt syndrome and the facial nerve is affected at the level of geniculate ganglion

The strict definition of the Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus.

Compared with Bell's palsy (facial paralysis without rash), patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely. Studies suggest that treatment with prednisone and acyclovir may improve outcome