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Herpes Zoster Oticus

(Geniculate Herpes; Ramsay Hunt Syndrome; Viral Neuronitis)


Lawrence R. Lustig

, MD, Columbia University Medical Center and New York Presbyterian Hospital

Last full review/revision Jun 2021| Content last modified Jun 2021
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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 Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. What causes the virus to reactive... read more Shingles ) is infection that results from a reactivation of the varicella-zoster virus, the virus that causes chickenpox Chickenpox Chickenpox is a highly contagious viral infection with the varicella-zoster virus that causes a characteristic itchy rash, consisting of small, raised, blistered, or crusted spots. Chickenpox... read more Chickenpox . After an episode of 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 herpes zoster virus is reactivated in the 7th (facial) and 8th cranial nerves Overview of the Cranial Nerves Twelve pairs of nerves—the cranial nerves—lead directly from the brain to various parts of the head, neck, and trunk. Some of the cranial nerves are involved in the special senses (such as seeing... read more . The 7th cranial nerve controls some muscles of the face. The 8th cranial nerve controls hearing and balance.

Symptoms of Herpes Zoster Oticus

The symptoms of herpes zoster oticus include the following:

Sometimes other cranial nerves are affected.

Diagnosis of Herpes Zoster Oticus

  • Physical examination

  • Sometimes laboratory tests of fluid from the blisters

  • Sometimes magnetic resonance imaging (MRI)

Treatment of Herpes Zoster Oticus

Doctors may give people drugs to relieve their symptoms and treat herpes zoster oticus. 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 and are routinely given to people whose immune system is weakened or impaired. Diazepam is given to relieve the attacks of vertigo. Opioids taken by mouth are given for pain. Other treatments may be given to people who have prolonged residual pain (called postherpetic neuralgia) such as medicated skin patches, antiseizure drugs, or tricyclic antidepressants.

People who have complete paralysis of the face may need a surgical procedure to relieve pressure on the facial nerve.

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