Which of the following is NOT typical of Ramsay Hunt syndrome?

• A. Painful vesicular rash around the ear, facial paralysis, hearing loss
• B. Fever and sore throat
• C. Chest pain
• D. Chronic cough

Answer: (C)

Ramsay Hunt syndrome is herpetic reactivation in the facial nerve (genicular ganglion) causing otic herpes zoster. The hallmark features are a painful vesicular eruption around the ear with ipsilateral facial paralysis and hearing loss (often with vertigo, tinnitus, or altered taste). These findings reflect involvement of cranial nerves VII and VIII and the inner ear. Fever and sore throat can accompany viral illnesses in general but are not defining features of Ramsay Hunt. Chest pain, on the other hand, points to cardiopulmonary or musculoskeletal causes and does not fit the cranial nerve–ear involvement pattern. Chronic cough likewise is not part of this syndrome. Therefore, chest pain is not typical of Ramsay Hunt syndrome.