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Herpes zoster oticus; Ramsay Hunt syndrome type 2

Etiology: - Herpes zoster Pathology: - involvement of cranial nerve VII & cranial nerve VIII Clinical manifestations: - cranial nerve VII - vesicular rash on pinna ear - initially, deep burning pain of the ear - vesicular eruption of the external auditory canal & concha generally occurs a few days after onset of pain - may be drainage of clear fluid from affected ear - ipsilateral facial paralysis (Bell's palsy) - loss of taste on anterior 2/3 of tongue - burning pain on ipsilateral 1/2 of tongue - cranial nerve VIII - vertigo - sensorineural hearing loss (ipsilateral) - Weber test lateralizes towards the contralateral ear - tinnitus - horizontal-torsional nystagmus - increases looking to the contralateral direction - decreases looking to the ipsilateral direction - dry mouth - dry eyes * images [2] Management: 1) referral to ENT [3] 2) acyclovir (Zovirax) 200 mg 5 times per day 3) high-dose glucocorticoids [5] 4) amitriptyline (Elavil) 75 mg QHS

Related

dyssynergia cerebellaris myoclonica; Ramsay-Hunt syndrome type 1; Ramsay-Hunt cerebellar syndrome

General

Herpes zoster (shingles) vestibular disorder (vestibulopathy) Ramsay-Hunt syndrome

References

  1. Baloh RW Dizziness in older people. J Am Geriatric Soc 40:713, 1992 PMID: 1607589
  2. Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
  3. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 41-4.
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, American College of Physicians, Philadelphia 2006, 2009
  5. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Uscategui T, Doree C, Chamberlain IJ et al. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008;(4):CD006851 PMID: 18843734 PMCID: PMC6956409 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006851.pub2/full
  7. Kim HJ, Jung J, Kim SS et al. Comparison of acyclovir and famciclovir for Ramsay Hunt Syndrome. Otol Neurotol. 2017;38(5):754-758 PMID: 28221283 https://journals.lww.com/otology-neurotology/Abstract/2017/06000/Comparison_of_Acyclovir_and_Famciclovir_for_Ramsay.26.aspx