Geniculate ganglionitis or geniculate neuralgia (GN), also called nervus intermedius neuralgia, Ramsay Hunt syndrome, or Hunts neuralgia, is a rare disorder characterized by severe paroxysmal neuralgic pain deep in the ear, that may spread to the ear canal, outer ear, mastoid or eye regions. GN may also occur in combination with trigeminal or glossopharyngeal neuralgia.The pain of GN is sharp, shooting or burning and can last for hours. Painful attacks can be triggered by cold, noise, swallowing or touch, but triggers are usually unique to the sufferer. Other related symptoms that may be experienced include increased salivation, bitter taste, tinnitus and vertigo. GN is rare, and only limited data is available regarding the incidence, prevalence, and risk factors associated with this condition. Middle-aged adults, however, seem to be predominantly affected, women more than men. Cause
GN may be caused by compression of somatic sensory branch of cranial nerve VII which goes through the nervus intermedius. In sufferers of GN, signals sent along these nerves are altered and interpreted by the geniculate ganglion (a structure in the brain) as GN pain. GN may also develop following herpes zoster oticus (Ramsay Hunt syndrome), where cold sores occur on the ear drum or ear. This may also be associated with facial paresis (weakness), tinnitus, vertigo and deafness. Disorders of lacrimation, salivation and/or taste sometimes accompany the pain. There is a common association with herpes zoster. Diagnosis
Diagnostic criteria:A. Pain paroxysms of intermittent occurrence, lasting for seconds or minutes, in the depth of the ear
B.
Other nephrotoxic drugs should be avoided. Nephrotoxicity is usually reversible and can be reduced by dosage adjustment and adequate hydration. Electrolyte disturbances — hypocalcemia and hypomagnesemia can occur and regular monitoring of electrolytes is necessary to avoid clinical toxicity. Genital ulceration — a less common reported side effect which occurs more in men and usually during induction use of foscarnet. It is most likely a contact dermatitis due to high concentrations of foscarnet in urine. It usually resolves rapidly following discontinuation of the drug. CNS — less common side effects of perioral paresthesia, irritability and altered mental states. References
Sources
Dennis L. Kasper, Eugene Braunwald. "Harrisons Manual of Medicine", 16th Edition, Mcgraw-hill, (2005), p. 2244. External links
"Foscarnet". Drug Information Portal. U.S. National Library of Medicine. "Foscarnet sodium". Drug Information Portal. U.S. National Library of Medicine.