ENT - Ramsey Hunt Syndrome, Auricular Haematoma, Nasopharyngeal Carcinoma

Question 1

Ramsey Hunt Syndrome - what is it?

Answer 1

Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve

Question 2

Ramsey Hunt Syndrome - clinical features?

Answer 2

• auricular pain is often the first feature
• facial nerve palsy
• vesicular rash around the ear
• other features include vertigo and tinnitus

Question 3

Ramsey Hunt Syndrome - management?

Answer 3

• oral aciclovir and corticosteroids are usually given

Question 4

Auricular Haematoma - what is it, and what is management?

Answer 4

Auricular haematomas are common in rugby players and wrestlers

Prompt treatment is important to avoid the formation of ‘cauliflower ear’

Management:

• same-day assessment by ENT
• incision and drainage has been shown to be superior to needle aspiration

Question 5

Nasopharyngeal carcinoma (NC) - what is it?

Answer 5

Squamous cell carcinoma of the nasopharynx

Rare in most parts of the world, apart from individuals from Southern China

Associated with Epstein Barr virus infection

Question 6

NC - clinical features?

Answer 6

Systemic - Cervical lymphadenopathy

Local - Otalgia, Unilateral serous otitis media, Nasal obstruction, discharge and/ or epistaxis, Cranial nerve palsies e.g. III-VI

Main feature is that is it otalgia without any other ear features - thinking secondary pain, and potentially cancer

Question 7

NC - investigations and management?

Answer 7

Combined CT and MRI

Treatment - Radiotherapy is first line therapy