Herpes zoster oticus
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
Diagnosis
- 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[2]
- Acyclovir 800mg 5 times a day x 7 days
- Famicyclovir 500mg TID x 7 days
- Valacyclovir 1000mg TID x 7 days
- 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
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
- ↑ Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008
- ↑ 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