Corticosteroids used in addition to antiviral drugs in patients with Ramsay Hunt syndrome

Ramsay Hunt syndrome (also known as herpes zoster oticus) consists of weakness of the face due to infection with the varicella zoster virus.  Five cases arise per 100,000 of the population per year in the US.  It is more common among those over 60 and rare in children. Other symptoms may include severe ear pain and small blisters on the outer ear or in the mouth.  Prompt diagnosis and treatment (ideally within 72 hours of the onset of symptoms) are crucial to secure the best outcomes. In cases where treatment has been started within this time period, facial weakness recovers in up to 75% of patients. Standard treatment is with antiviral therapy (most commonly acyclovir). Corticosteroids are known for their anti-inflammatory properties and are commonly used together with antivirals to reduce the inflammation in the facial nerve.  This is thought to be the cause of the facial weakness.  The aim of the review was to see if corticosteroids, used at the same time as antiviral drugs, improved outcomes in patients with Ramsay Hunt syndrome.  However the review found no trials matching the inclusion criteria, and no conclusions can be drawn about the effectiveness of using corticosteroids in this way.   It is recommended that high-quality randomised controlled trials be undertaken to address this issue.

Authors' conclusions: 

Since no randomised controlled trials investigating the use of corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome were identified, such studies are needed to assess the effects of such therapy.

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Background: 

Inflammation and oedema of the facial nerve due to viral infection by the herpes zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to play in the reduction or minimisation of nerve damage when administered together with antiviral therapy, and therefore may improve the outcome for patients with Ramsay Hunt syndrome.

Objectives: 

To determine the effectiveness of corticosteroids as an adjuvant to antiviral therapy in adult patients with Ramsay Hunt syndrome (herpes zoster oticus with facial palsy).

Search strategy: 

We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 4, 2007), MEDLINE (1950 to December 2007) and EMBASE (1974 to December 2007), CINAHL (1982 to December 2007), LILACS, KoreaMed, IndMed, PakMediNet, ZETOC, Cambridge Scientific Abstracts (Conference Proceedings Database), ISI Proceedings (Web of Science), the National Research Register (NRR), the UK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Research Findings Register (ReFeR) and the metaRegister of Controlled Trials (mRCT).

Selection criteria: 

All randomised controlled trials in which corticosteroids (by any route of administration at any dosage) were given as an adjuvant to antiviral agents in the treatment of Ramsay Hunt syndrome.

Data collection and analysis: 

Two reviewers independently assessed eligibility and trial quality of the available studies, whether they were published or unpublished. No trials were found and therefore no data were analysed.

Main results: 

This is an empty review as no trials were found that fulfilled the inclusion criteria.

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