Herpes zoster oticus

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Background

  • Also know as "Herpes Zoster Oticus"
  • 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

  • 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

Workup

  • History and physical
  • 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
  1. Oral analgesia
  2. Antiviral Options[2]
    1. Acyclovir 800mg 5 times a day x 7 days
    2. Famicyclovir 500mg TID x 7 days
    3. Valacyclovir 1000mg TID x 7 days
  3. Prednisone

Prognosis

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

Disposition

  • Outpatient PMD followup

See Also

Sources

  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
  • 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