Herpes zoster of ear

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Overview

Herpes zoster virus, also known as shingles, results from the reactivation of latent varicella-zoster virus, which infiltrates the sensory ganglia during varicella. Herpes zoster oticus (HZ oticus), also known as Ramsay Hunt syndrome, is a viral infection of the inner, middle, and external ear caused by spread of the varicella-zoster virus to the facial nerves. HZ oticus manifests as severe otalgia; vesicular eruption involving the mouth, external ear canal, and pinna; and may cause facial paralysis. Other symptoms may include hearing impairment, vertigo, severe facial pain, and tinnitus.

Symptoms

The most visible symptoms of Ramsay Hunt syndrome are a shingles rash near one or both ears and abnormal paralysis in the face. With this syndrome, facial paralysis is noticeable on the side of the face that’s affected by the shingles rash. When your face is paralyzed, the muscles may feel harder or impossible to control, as if they’ve lost their strength.


A shingles rash can be spotted by its red, pus-filled blisters. When you have Ramsay Hunt syndrome, the rash may be inside, outside, or around the ear. In some cases, the rash can also appear in your mouth, especially on the roof of your mouth or top of your throat. In other cases, you may not have a visible rash at all, but still have some paralysis in your face.


Other common symptoms of Ramsay Hunt syndrome include:


pain in your affected ear

pain in your neck

ringing noise in your ear, also called tinnitus

hearing loss

trouble closing the eye on the affected side of your face

decreased sense of taste

a feeling like the room is spinning, also called vertigo

slightly slurred speech


Causes

Ramsay Hunt syndrome isn’t contagious on its own, but it does mean you have the shingles virus. Exposing someone to the varicella-zoster virus if they haven’t had a previous infection can give them chicken pox or shingles.


Because Ramsay Hunt syndrome is caused by shingles, it has the same causes and risk factors. These include:


previously having chicken pox

being older than 60 years (it rarely occurs in children)

having a weak or compromised immune system


Risk factors

Family history of zoster, physical trauma, and older age also significantly increased risk. Although the risk is present with female gender, psychological stress, or presence of comorbidities, such as diabetes, RA, CVDs, renal disease, SLE, and IBD, it was slightly less than the former risk factors.

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Complications

If Ramsay Hunt syndrome is treated within three days of the symptoms appearing, you shouldn’t have any long-term complications. But if it goes untreated long enough, you may have some permanent weakness of the facial muscles or some loss of hearing.


In some cases, you may not be able to close your affected eye completely. As a result, your eye may get extremely dry. You may also be unable to blink out any objects or matter that gets in your eye. If you don’t use any eye drops or lubrication, it’s possible to damage the surface of the eye, called the cornea. Damage can cause constant corneal irritation or permanent (although usually minor) vision loss.


If Ramsay Hunt syndrome damages any of your facial nerves, you might also feel pain, even after you don’t have the condition anymore. This is known as postherpetic neuralgia. The pain happens because the damaged nerves don’t detect sensations correctly and send the wrong signals to your brain.

Prevention

In the general population, the use of a live-attenuated zoster vaccine (Zostavax, Merck) has been shown to decrease the risk for herpes zoster development by about 50%.