HZO Prognosis

Generally, the prognosis of herpes zoster oticus is good. However in clinical practice, prognosis of Herpes Zoster Oticus (Ramsay Hunt Syndrome) depends on the severity of the damage to the nerve. If it is at the minimum level, usually a full recovery expected within couple of weeks.  If damage is more severe, full recovery may take quite a long time (usually takes couple of months). The best results are taken with the initiation of the treatment 3 days after the onset of the symptoms. Rapid start to the therapy usually ends  up with high clinical success rate. If there is a delay to start the treatment more than 3 days, clinical success rates falls to 50%.

If the complete recovery falls to %50 of the patients;

• Long term hearing damage may occur  (permanent hearing loss)
• Vertigo may continue for eight months after herpes zoster oticus where the initial set of this complication may end with severe nausea and vomiting. Vertigo may last for days or weeks.
• Facial paralysis may be permanent

Children population has a higher clinical success rate comparing to adult population.

With the existence of synkinesis where patient’s nerve grows back to wrong areas it may cause inappropriate responses including:

• Tears when laughing or chewing
• Blinking of the eye when talking or eating food.

In some clinical trials nerve enhancement limited to the geniculate ganglion and to the labyrinthine segment of the facial nerve indicates a good prognosis while a widespread enhancement correlates with a poor prognosis.

In Herpes Zoster Oticus cases, factors predicting good prognosis are as provided below:

• Low degree of facial palsy on admission
• Delayed onset of facial palsy from initial symptom
• Early treatment for facial palsy  (because the prognosis of the facial palsy is usually poor)
• Electrical test: Nerve excitability test(<3.5 mA difference) Electroneurography(>10%)