Question 120

Question:

A 68-year-old man arrives at your family practice clinic complaining of a week of left-sided ear pain. For the last two days, he has been drooling from the corner of his mouth. Physical exam reveals a left-sided facial weakness. Otoscopic examination is significant for a small cluster of vesicles in the left external auditory canal. What other associated symptom would you expect the patient to report?

Correct Answer: B.  Altered taste of food

Ramsay-Hunt Syndrome, or Herpes Zoster Oticus, is caused by the reactivation of VZV in the geniculate ganglion. It classically presents with an ipsilateral Bell’s palsy, ear pain, and clusters of clear or hemorrhagic vesicles in the external ear canal. It is frequently associated with a loss of taste in the anterior portion of the tongue.
While you may not know specifically about Ramsay-Hunt Syndrome, you should be able to reason that the patient has a problem with their CN-VII. Recall that the geniculate nucleus (responsible for controlling CN-VII) is also the termination for the frequently-tested chorda tympani nerve, responsible for conveying taste from the anterior two-thirds of the tongue.
Because zoster reactivates in only one dermatome (here, a cranial nerve), we would not expect to see problems with CNs I (smell), II (vision), XII (tongue deviation), or the contralateral CN-VIII (hearing in the RIGHT ear).