Herpes zoster oticus: Difference between revisions
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==Background== | ==Background== | ||
*Also know as "Herpes Zoster Oticus" | *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]] | *Caused by [[herpes zoster]] | ||
==Clinical Features== | ==Clinical Features== | ||
*URI symptoms common for 1-3 days prior | |||
*Paroxysmal 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 | ||
**Develop over 3-7 days | **Develop over 3-7 days | ||
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*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== | ||
*Most effective when started within 3 days of symptom onset | |||
#Oral analgesia | #Oral analgesia | ||
#Antiviral Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref> | #Antiviral Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref> | ||
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##Famicyclovir 500mg TID x 7 days | ##Famicyclovir 500mg TID x 7 days | ||
##Valacyclovir 1000mg TID x 7 days | ##Valacyclovir 1000mg TID x 7 days | ||
#Prednisone | |||
==Prognosis==<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> | |||
*Poor prognostic factors for good functional recovery include | |||
**age older than 50 years | |||
**complete facial paralysis | |||
**lack of CN VII nerve excitability | |||
==Disposition== | ==Disposition== | ||
*Outpatient PMD followup | *Outpatient PMD followup | ||
==See Also== | ==See Also== | ||
*[[Herpes Zoster Ophthalmicus]] | |||
*[[Otitis Externa]] | *[[Otitis Externa]] | ||
*[[Otitis Media|Perforated Otitis Media]] | *[[Otitis Media|Perforated Otitis Media]] | ||
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==Sources== | ==Sources== | ||
<references/> | <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 | |||
*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 | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Neuro]] | |||
Revision as of 15:47, 4 January 2015
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
- 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==[3]
- Poor prognostic factors for good functional recovery include
- age older than 50 years
- complete facial paralysis
- lack of CN VII nerve excitability
Disposition
- Outpatient PMD followup
See Also
Sources
- ↑ 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
- 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