First-line pharmacologic therapy for Ramsay Hunt syndrome is

• A. Antibiotics
• B. Antiviral alone
• C. Oral acyclovir + corticosteroids
• D. Corticosteroids alone

Answer: (C)

Ramsay Hunt syndrome arises from reactivation of varicella-zoster virus in the facial nerve region, causing facial paralysis with ear vesicles. The aim of therapy is to curb viral replication while reducing the inflammatory swelling that damages the nerve. Combining an antiviral with a corticosteroid achieves both: the antiviral limits viral replication in the affected nerves, and the corticosteroid decreases edema and inflammation around the nerve, improving chances of recovery. Starting treatment early, ideally within 72 hours of onset, leads to the best outcomes. That’s why the first-line pharmacologic approach is an antiviral such as acyclovir (or valacyclovir) plus a corticosteroid like prednisone. Antibiotics don’t address the viral cause, and corticosteroids alone don’t control viral replication, so they aren’t first-line.