You are correct. The presence of ear pain w/ vesicular rash and facial paralysis is consistent w/ Ramsay Hunt syndrome (RHS), a rare complication of the reactivation of latent varicella zoster virus in the geniculate ganglion. It can also occur w/ ipsilateral palate alteration; tongue lesions; hearing impairment (deafness, tinnitus, hyperacusis); lacrimation; and vertigo. Compared w/ pts w/ Bell palsy, pts w/ RHS often have more severe paralysis at the onset and are less likely to recover completely. An acoustic neuroma can cause facial palsy but is more likely in pts who report hearing loss or tinnitus or have an unsteady gait. Forehead involvement distinguishes peripheral facial palsy from central causes.

Emergency Medicine Journal 2019;36:665-683.