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Herpes Zoster Oticus

(Ramsay Hunt Syndrome; Viral Neuronitis)

By Lawrence R. Lustig, MD

Herpes zoster oticus is herpes zoster virus infection of the clusters of nerve cells (ganglia) that control the nerves responsible for hearing and balance (8th cranial nerve) and for facial movement (7th cranial nerve).

Herpes zoster (shingles―see see page Shingles) is infection that results from a reactivation of the varicella-zoster virus, the virus that causes chickenpox. This virus lies dormant in nerve roots and can be reactivated, travelling down the nerve fibers to the skin, where it causes painful sores. Most often the cause of reactivation is unknown but sometimes it occurs when the immune system is weakened, for example, by cancer, AIDS, or certain drugs.

Herpes zoster oticus occurs when the virus occupies the 7th and 8th cranial nerves. These nerves control hearing, balance, and some muscles of the face. Thus herpes zoster oticus causes severe ear pain, temporary or permanent paralysis of the face (similar to Bell palsy―see page Bell Palsy), vertigo (a false sensation of moving or spinning) that lasts days to weeks, and hearing loss (which may be permanent or which may resolve partially or completely). Fluid-filled blisters (vesicles) occur on the outside of the ear (pinna) and in the ear canal. People rarely have headache, confusion, or a stiff neck. Sometimes other cranial nerves are affected.

Doctors typically base the diagnosis on a physical examination.

Doctors usually give people drugs to alleviate their symptoms. However, it is not clear whether these drugs help very much. Corticosteroids such as prednisone are given to block inflammation. Antiviral drugs such as acyclovir or valacyclovir may help reduce the duration of the infection. Diazepam is given to alleviate the attacks of vertigo. Opioids taken by mouth are given for pain. People who have complete paralysis of the face may need a surgical procedure to relieve pressure on the facial nerve.

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