jmj11 Posted July 13, 2011 Share Posted July 13, 2011 We had one patient in a MVA on the way to his appointment this morning. This opened up a 30 minute slot for me to urgently bike down to the bank and straighten out a business account, bike over the post office and pick up our mail. By the time I got back to the office my next 90 consult was filling out paper work, plus there was a new patient laying in the treatment room, having been sent over from ENT as an emergency. So, this "quickie work in" took 75 minutes and got me very behind. But it is an interesting case. I will this quick and as a riddle. 47 year old woman with severe electric type of pain radiating from her right ear for 5 days. Also, she noticed asymmetry of her face (very slight flattened nasolabial fold on the right) and a "swollen ear." Her external canal and meatus was swollen red, and painful. ENT has already said there is no OM or OE going on. So, what do you think? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 13, 2011 Moderator Share Posted July 13, 2011 ramsay hunt syndrome? ( early, before significant presentation of vessicles?) Link to comment Share on other sites More sharing options...
jmj11 Posted July 13, 2011 Author Share Posted July 13, 2011 ramsay hunt syndrome? ( early, before significant presentation of vessicles?) BINGO! Always something new isn't there. Oddly, she has vesicles in her nose a few days before this all started. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 14, 2011 Moderator Share Posted July 14, 2011 surprised ent didn't pick up on this....you know problems around the ear and all.... Link to comment Share on other sites More sharing options...
jmj11 Posted July 14, 2011 Author Share Posted July 14, 2011 surprised ent didn't pick up on this....you know problems around the ear and all.... I think they probably did. It is strange but they sent her directly over to me and I never heard from them or saw their notes (they send me a lot of patients). She had a script in hand for prednisone and she has acyclovir at home (recurrent herpes simplex). Once I talked about Ramsay Hunt she said she thinks that's what ENT were thinking too. I think the reason they told her to come directly over to my clinic is because of the intense pain she was in and to make sure it wasn't some other weird headache syndrome. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 21, 2011 Moderator Share Posted July 21, 2011 wow - just saw this in the office and Dx it because of this thread.... question - do you have to have opthal eval if this is likely Dx or just valtrex and close follow up? addendum and just saw my second one in the same day...... strange how that happens... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 21, 2011 Moderator Share Posted July 21, 2011 wow - just saw this in the office and Dx it because of this thread.... question - do you have to have opthal eval if this is likely Dx or just valtrex and close follow up? addendum and just saw my second one in the same day...... strange how that happens... Link to comment Share on other sites More sharing options...
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