Difference between revisions of "Herpes zoster oticus"

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==Background==
 
==Background==
*Also know as "Herpes Zoster Oticus"
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*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
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*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 CN VII but may involve CN VIII
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*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
 
**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
 
**vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo
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==Clinical Features==
 
==Clinical Features==
*URI symptoms common for 1-3 days prior
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[[File:Ramsey Hunt Syndrome.png|thumb|Ear findings and facial droop classic for Ramsey Hunt Syndrome.]]
*Paroxysmal 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>  
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*[[URI]] symptoms common for 1-3 days prior
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*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
 
**Usually precedes the rash by several hours and even days
 
**Erythema and Swelling of auricle
 
**Erythema and Swelling of auricle
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==Differential Diagnosis==
 
==Differential Diagnosis==
*[[Otitis Externa]]
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{{Facial paralysis}}
*[[Otitis Media|Perforated Otitis Media]]
 
*[[Bell's Palsy]]
 
*[[CVA]]
 
  
==Workup==
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{{Ear DDX}}
*History and physical
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 +
{{VZV types}}
 +
 
 +
==Evaluation==
 
*Otoscopy
 
*Otoscopy
*Neuro exam focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement
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*[[Neuro exam]] focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement
  
 
==Management==
 
==Management==
*Most effective when started within 3 days of symptom onset
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''Most effective when started within 3 days of symptom onset''
#Oral analgesia
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*Oral [[analgesia]]
#Antiviral Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref>
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*[[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
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**[[Acyclovir]] 800mg 5 times a day x 7 days
##Famicyclovir 500mg TID x 7 days
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**[[Famciclovir]] 500mg TID x 7 days
##Valacyclovir 1000mg TID x 7 days
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**[[Valacyclovir]] 1000mg TID x 7 days
#Prednisone
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*[[Prednisone]] 60mg qday x 7 days
 +
 
 +
==Disposition==
 +
*Outpatient primary care follow-up
  
 
==Prognosis==
 
==Prognosis==
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**lack of CN VII nerve excitability
 
**lack of CN VII nerve excitability
  
==Disposition==
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==See Also==
*Outpatient PMD followup
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*[[Herpes zoster ophthalmicus]]
  
==See Also==
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==Video==
*[[Herpes Zoster Ophthalmicus]]
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{{#widget:YouTube|id=YxjhX9lHe_g}}
*[[Otitis Externa]]
 
*[[Otitis Media|Perforated Otitis Media]]
 
*[[Bell's Palsy]]
 
*[[CVA]]
 
  
==Sources==
+
==References==
 
<references/>
 
<references/>
*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
 
*Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. Oct 8 2008
 
  
[[Category:Ophtho]]
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[[Category:Dermatology]]
 
[[Category:ID]]
 
[[Category:ID]]
[[Category:Neuro]]
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[[Category:Neurology]]
 +
[[Category:ENT]]

Latest revision as of 16:29, 3 February 2020

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 CN VII but may involve 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

Clinical Features

Ear findings and facial droop classic for Ramsey Hunt Syndrome.
  • URI symptoms common for 1-3 days prior
  • Paroxysmal pain deep within ear: radiates outward into the pinna of the ear[1]
    • 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 Diagnoses

External

Internal

Inner/vestibular

Varicella zoster virus

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

Disposition

  • Outpatient primary care follow-up

Prognosis

  • Poor prognostic factors for good functional recovery include[3]
    • age older than 50 years
    • complete facial paralysis
    • lack of CN VII nerve excitability

See Also

Video

References

  1. 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
  2. Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008
  3. 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