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Herpes zoster oticus
From WikEM
Contents
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
- 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
- Bell's Palsy
- CVA
- Trigeminal neuralgia
- Tick paralysis
- Herpes zoster oticus (Ramsay Hunt syndrome)
- CNS tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannoma
- Parotid
- Sarcoma
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
Ear Diagnoses
- External
- Auricular hematoma
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Mastoiditis
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
- Internal
- Acute otitis media
- Bullous myringitis
- Chronic otitis media
- Mastoiditis
- Otic barotrauma
- Inner/vestibular
Varicella zoster virus
- Varicella (Chickenpox)
- Herpes zoster (Shingles)
- Herpes zoster ophthalmicus
- Herpes zoster oticus (Ramsay Hunt syndrome)
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[2]
- Acyclovir 800mg 5 times a day x 7 days
- Famicyclovir 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[3]
- age older than 50 years
- complete facial paralysis
- lack of CN VII nerve excitability
See Also
Video
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
