Herpes zoster oticus: Difference between revisions

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==Background==
==Background==
Also know as "Herpes Zoster Oticus" which is an infection of the auricle with associated facial paralysis usually involving CN VII but may involve CN V.
*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 [[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
**vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo
*Caused by [[herpes zoster]]
 
{{Herpes viruses}}
 
==Clinical Features==
==Clinical Features==
[[File:Ramsey Hunt Syndrome.png|thumb|Ear findings and facial droop classic for Ramsey Hunt Syndrome.]]
*[[URI]] symptoms common for 1-3 days prior
*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
**Erythema and Swelling of auricle
**Vesicles within external ear canal and on auricle
*Facial pain
*Facial pain
*Errytema and Swelling of auricle
*Vesicles within external ear canal and on auricle
**Develop over 3-7 days
**Develop over 3-7 days
==Differential Diagnosis==
==Differential Diagnosis==
*[[Otitis Externa]]
{{Facial paralysis}}
*[[Otitis Media|Perforated Otitis Media]]
 
*[[Bells Palsy]]
{{Ear DDX}}
*[[CVA]]
 
==Workup==
{{VZV types}}
*History and physical
 
==Evaluation==
*Otoscopy
*Otoscopy
*Neuro exam focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement
*[[Neuro exam]] focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement
 
==Management==
==Management==
#Oral analgesia
''Most effective when started within 3 days of symptom onset''
#Antiviral Options
*Oral [[analgesia]]
##Acyclovir 800mg 5 times a day x 7 days
*[[Antiviral]] Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref>
##Famicyclovir 500mg TID x 7 days
**[[Acyclovir]] 800mg 5 times a day x 7 days
##Valacyclovir 1000mg TID x 7 days
**[[Famciclovir]] 500mg TID x 7 days
**[[Valacyclovir]] 1000mg TID x 7 days
*[[Prednisone]] 60mg qday x 7 days
 
==Disposition==
==Disposition==
*Outpatient PMD followup
*Outpatient primary care follow-up
 
==Prognosis==
*Poor prognostic factors for good functional recovery include<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>
**age older than 50 years
**complete facial paralysis
**lack of CN VII nerve excitability
 
==See Also==
==See Also==
*[[Otitis Externa]]
*[[Herpes zoster ophthalmicus]]
*[[Otitis Media|Perforated Otitis Media]]
 
*[[Bells Palsy]]
==References==
*[[CVA]]
==Sources==
<references/>
<references/>
[[Category:Dermatology]]
[[Category:ID]]
[[Category:Neurology]]
[[Category:ENT]]

Latest revision as of 20:00, 17 April 2024

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

Herpes Virus Types

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

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
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