Herpes zoster oticus
From Ganfyd
Web Resources for Herpes zoster oticus
ICD 10 code: G53.0
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Herpes zoster oticus (Less technical, good quality control)
Wikipedia on Herpes zoster oticus (Less technical, ? quality control)
Contents |
Introduction
In 1907 James Ramsay Hunt suggested that herpes zoster oticus resulted from a geniculate ganglionitis although many regard it as a neuritis or polycranial neuropathy. This cause (latent herpes zoster) of the syndrome is now a specific disease entity[1][2][3]. Treatment is with antivirals such as acyclovir and corticosteroids[4] although there are no randomised controlled trials. Occasionally surgical decompression of the facial nerve is necessary.
Pathology
Inflammatory involvement of the geniculate ganglion and its nearly related vestibulocochlear nerve within the bony facial canal as per James Ramsay Hunt's classical description.
Features
The syndrome has:
- Cochleovestibular symptoms
- Facial paralysis
- Usual dense
- Recovery can be prolonged
and was first described by Letulle in 1882. The additional criteria specific to herpes zoster is
- Erythematous vesicular rash on the ear (zoster oticus) or in the mouth.
It may be associated with:
- Paralysis of other cranial nerves.
- Severe otalgia
- Ear canal oedema
Due to evolution of signs it may initially be indistinguishable from Bell's palsy. Indeed a proportion of patients with this later condition have herpes zoster rather than herpes simplex as the cause
The facial palsy and 8th nerve symptoms can also be caused by acute otitis media due to herpes simplex and bacteria[5].
Investigations
- Audiogram (pain permitting)
- CT scan to exclude abscess formation
Management
- Antiviral drug :Acyclovir, adult dose is 800mg, five times per day for 7 days
- Analgesia
- Splint ear canal with Pope wick
- Antibiotic/steroid drops reduce otalgia and swelling
References
- ↑ Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. The Journal of laryngology and otology 2002;116(10):844-8. (Direct link – subscription may be required.)
- ↑ Ohtani F, Furuta Y, Aizawa H, Fukuda S. Varicella-zoster virus load and cochleovestibular symptoms in Ramsay Hunt syndrome. The Annals of otology, rhinology, and laryngology 2006;115(3):233-8.
- ↑ Aizawa H, Ohtani F, Furuta Y, Sawa H, Fukuda S. Variable patterns of varicella-zoster virus reactivation in Ramsay Hunt syndrome. Journal of medical virology 2004;74(2):355-60. (Direct link – subscription may be required.)
- ↑ Van de Steene V, Kuhweide R, Vlaminck S, Casselman J. Varicella zoster virus: beyond facial paralysis. Acta oto-rhino-laryngologica Belgica 2004;58(1):61-6.
- ↑ Hydén D, Akerlind B, Peebo M. Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology. Acta oto-laryngologica 2006;126(5):460-6. (Direct link – subscription may be required.)
