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A 45-year-old woman presents with a left-sided facial palsy and vertigo. She has impaired hearing on her left side and a vesicular rash is noted around her external auditory meatus.

J Ramsay Hunt syndrome is the name attributed to herpes zoster infection of the geniculate ganglion. The external auditory meatus receives some sensory innervation from the facial (VII) nerve, hence the vesicular rash over this area. A course of acyclovir and glucocorticoid, e.g. prednisolone, is the treatment of choice. Complete recovery may be achieved in up to 75 per cent of cases if treatment is implemented within the first 3 days of facial paralysis.