MOLECULAR TEMPORAL BONE PATHOLOGY .2. RAMSAY-HUNT-SYNDROME (HERPES-ZOSTER OTICUS)

In 1907 J. Ramsay Hunt suggested that herpes tester oticus resulted fr om a geniculate ganglionitis; however, many contemporary authors belie ve that this disorder represents a neuritis or polycranial neuropathy, Herpes varicella-zoster viral (VZV) DNA was identified, using the pol ymerase chain reaction, in archival celloidin-embedded temporal bone s ections from two patients who clinically had Ramsay Hunt syndrome (her pes tester oticus), The presence of VZV was confirmed by sequencing th e PCR products. These experiments demonstrated that VZV genomic DNA wa s present in the geniculate ganglion of the side with facial paralysis and cutaneous recrudescence in both patients and in the clinically un affected side in patient 1. In addition, patient 2 had a sudden hearin g loss and was found to have VZV genomic DNA in sections from the affe cted side containing the spiral ganglion, Scarpa's ganglion, organ of Corti, and macula of the saccule, No VZV genomic DNA was identified in temporal bone sections from five patients with Bell's palsy and ten p atients without evidence of otologic disease. In this study, the histo pathology of these two cases yielded complementary information regardi ng the role of VZV in herpes tester oticus. These data suggest that in patients with Ramsay Hunt syndrome, latent VZV is located in the geni culate ganglia and may be present in the auditory and vestibular prima ry afferent ganglia in some patients.