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 
) is infection that results from a reactivation of the varicella-zoster virus, which 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 
. After an episode of chickenpox, the 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 medications.
Herpes zoster oticus occurs when the herpes zoster virus is reactivated in the 7th (facial) and 8th (auditory or vestibulocochlear) 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.
(See also Overview of the Inner Ear Overview of the Inner Ear The fluid-filled inner ear (labyrinth) is a complex structure consisting of two major parts: The organ of hearing (cochlea) The organ of balance (vestibular system) The cochlea and the vestibular... read more .)
Symptoms of Herpes Zoster Oticus
The symptoms of herpes zoster oticus include the following:
Severe ear pain
Fluid-filled blisters (vesicles) on the outside of the ear (pinna) and in the ear canal
Temporary or permanent paralysis of one side of the face (similar to Bell palsy Bell Palsy Bell palsy (a type of facial nerve palsy) is sudden weakness or paralysis of muscles on one side of the face due to malfunction of the 7th cranial nerve (facial nerve). This nerve moves the... read more )
Vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more (a false sensation of moving or spinning) that lasts days to weeks
Hearing loss Hearing Loss and Deafness , which may be permanent or which may resolve partially or completely
Rarely, headache, confusion, or a stiff neck
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)
Doctors typically base the diagnosis of herpes zoster oticus on results of a physical examination. Sometimes doctors take scrapings of the vesicles for examination under a microscope and for culturing Culture Doctors can identify many skin disorders simply by looking at the skin. A full skin examination includes examination of the scalp, nails, and mucous membranes. Sometimes the doctor uses a hand-held... read more 
. MRI Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more 
may also be done to make sure the symptoms are not caused by another disorder.
Treatment of Herpes Zoster Oticus
Sometimes corticosteroids, such as prednisone, to reduce inflammation
Sometimes antiviral medications to treat the infection
Rarely surgery to relieve pressure on the facial nerve
Doctors may give people medications to relieve their symptoms and treat herpes zoster oticus. However, it is not clear whether these medications help very much. Corticosteroids such as prednisone are given to block inflammation. Antiviral medications 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 vertigo. Opioids taken by mouth are given for severe pain.
Other treatments may be given to people who have prolonged residual pain (called postherpetic neuralgia Postherpetic Neuralgia Postherpetic neuralgia is chronic pain in areas of skin supplied by nerves infected with herpes zoster ( shingles). Shingles is a painful rash of fluid-filled blisters that is caused by reactivation... read more ). These treatments include medicated skin patches, antiseizure medications, and tricyclic antidepressants.
People who have complete paralysis of the face may need a surgical procedure to relieve pressure on the facial nerve.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
prednisone |
Deltasone, Predone, RAYOS, Sterapred, Sterapred DS |
acyclovir |
SITAVIG, Zovirax, Zovirax Cream, Zovirax Ointment, Zovirax Powder, Zovirax Suspension |
valacyclovir |
Valtrex |
diazepam |
Diastat, Dizac, Valium, VALTOCO |
