View source for Herpes zoster oticus

==Background==
*Also know as "Ramsay Hunt syndrome"
*Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle, or mucous membrane of the oropharynx
*Associated facial paralysis usually involving [[Cranial nerve palsies|CN VII]] but may involve [[Cranial nerve palsies|CN VIII]]
**geniculate ganglion: movements of the facial muscles, sensation of parts of the ear and ear canal, taste function of the tongue, and lubrication of the eyes and oral mucosa
**vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo
*Caused by [[herpes zoster]]

{{Herpes viruses}}

==Clinical Features==
[[File:Ramsey Hunt Syndrome.png|thumb|Ear findings and facial droop classic for Ramsey Hunt Syndrome.]]
*[[URI]] symptoms common for 1-3 days prior
*Paroxysmal [[earache|pain]] deep within ear: radiates outward into the pinna of the ear<ref>Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011</ref> 
**Usually precedes the rash by several hours and even days
**Erythema and Swelling of auricle
**Vesicles within external ear canal and on auricle
*Facial pain
**Develop over 3-7 days

==Differential Diagnosis==
{{Facial paralysis}}

{{Ear DDX}}

{{VZV types}}

==Evaluation==
*Otoscopy
*[[Neuro exam]] focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement

==Management==
''Most effective when started within 3 days of symptom onset''
*Oral [[analgesia]]
*[[Antiviral]] Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref>
**[[Acyclovir]] 800mg 5 times a day x 7 days
**[[Famciclovir]] 500mg TID x 7 days
**[[Valacyclovir]] 1000mg TID x 7 days
*[[Prednisone]] 60mg qday x 7 days

==Disposition==
*Outpatient primary care follow-up

==Prognosis==
*Poor prognostic factors for good functional recovery include<ref>Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011</ref>
**age older than 50 years
**complete facial paralysis
**lack of CN VII nerve excitability

==See Also==
*[[Herpes zoster ophthalmicus]]

==References==
<references/>

[[Category:Dermatology]]
[[Category:ID]]
[[Category:Neurology]]
[[Category:ENT]]