Fifty two children, aged 2 to 15 years, diagnosed with Ramsay Hunt syndrome (RHS) in a 20 year period between 1976 and 1996 are reported from the Facial Nerve Clinic, Ehime University Hospital, Japan. Eighteen were under 6 years of age (preschoolers) and 34 were older children. The diagnosis of RHS was made from signs of facial palsy, herpetic vesicles on the auricles or oral mucosa, and vestibulo-cochlear dysfunction. Vesicles, occurring in 81% of patients, developed several days after the facial palsy in 50% of cases. Hearing loss was detected in 24% of children, 11% complained of tinnitus, and 17% had vertigo. Symptoms in children were milder than in adults, and the prognosis was better. Complete recovery of facial palsy occurred in three quarters, and none had a severe residual paralysis. Hearing recovered in two thirds. In patients without vesicles, diagnosis was confirmed by a complement-fixation assay of the serum, when the VZV-specific antibody increased four-fold between acute and convalescent phases. None had received varicella vaccine. 
COMMENT. The clinical symptoms of Ramsay Hunt syndrome are milder in children and the outcome better than in adults. Children have stronger specific immunity against the varicella-zoster virus, and this may minimize the reactivation of the virus. Delayed appearance of vesicles may lead to misdiagnosis as Bell’s palsy. Early administration of acyclovir will improve the prognosis of the facial palsy and hearing loss.