Facial palsy in a 38-year-old man. Ramsay Hunt syndrome.

Volume 88, Number 11 www.aafp.org/afp American Family Physician 771 A 38-year-old man presented with a painful rash on his right ear that had lasted for seven days. Over the previous four days, he developed ipsilateral tinnitus and progressive difficulty in closing his right eye and mouth. He had no notable medical history. On examination, he had multiple vesicles on an erythematous base on the concha of his right ear (Figure 1). Neurologic examination showed right-sided hearing impairment and lower motor neuron facial palsy with lagophthalmos, an inability to smile on the affected side, and loss of definition in the right nasolabial fold (Figure 2). Question