A 70 year old male presents with loss of sensation in external auditory meatus (Hitzelberg’s sign positive).The likely diagnosis is –
## **Core Concept**
The question describes a patient presenting with loss of sensation in the external auditory meatus, which is associated with Hitzelberg's sign. This clinical presentation suggests involvement of the **auriculotemporal nerve**, a branch of the mandibular division of the trigeminal nerve (V3), which provides sensory innervation to the external auditory meatus.
## **Why the Correct Answer is Right**
The correct answer, **Ramsay Hunt syndrome type 2**, is a condition caused by reactivation of varicella-zoster virus in the geniculate ganglion of the facial nerve. This syndrome can lead to **geniculate neuralgia** and is associated with **Hitzelberg's sign**, which is the loss of sensation in the external auditory meatus due to involvement of the auriculotemporal nerve. The syndrome presents with severe pain in the ear and sometimes facial paralysis or other cranial nerve symptoms.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because it does not specify a condition related to the symptoms described.
- **Option B:** This option is incorrect because, although it might relate to ear symptoms, it does not specifically correlate with Hitzelberg's sign and the described sensory loss.
- **Option C:** This option is incorrect because it does not directly relate to the clinical presentation of loss of sensation in the external auditory meatus and Hitzelberg's sign.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that **Ramsay Hunt syndrome type 2** often presents with a triad of ear pain, vesicles in the ear (herpes zoster oticus), and facial paralysis. However, not all symptoms may be present in every case. The presence of Hitzelberg's sign supports the diagnosis by indicating involvement of the auriculotemporal nerve.
## **Correct Answer:** D. Ramsay Hunt syndrome type 2.