Herpes Zoster Oticus: Ramsay Hunt Syndrome

Herpes zoster oticus (HZ oticus) is a complication of shingles, an infection caused by the varicella-zoster virus (VZV) which also causes chickenpox. It is more likely to happen in people who have had chickenpox earlier and represents a reactivation of the dormant varicella-zoster virus. The virus spreads to the facial and sensory nerves innervating the ear with geniculate ganglion which is responsible for HZ oticus. The virus transmits through direct proximity of the cranial nerve (CN) VIII to CN VII at the cerebellopontine angle or through vasa vasorum that travel from CN VII to other nearby cranial nerves.

Causes for Herpes Zoster Oticus

Herpes zoster oticus is caused by the revival of latent VZV, which might have remained dormant within sensory ganglia of the facial nerve. People with decreased cell-mediated immunity resulting from carcinoma, chemotherapy, radiation therapy, or HIV infection, are at a higher risk of getting infected by the disease. A weak immune system (system not capable of destroying the varicella-zoster virus during the initial infection), physical and emotional stress can also be precipitating causes for herpes zoster oticus.

Signs and Symptoms for Herpes Zoster Oticus

The most prominent symptom, is often pain, deep within the ear. It may appear paroxysmal initially, but after a few days, the pain often radiates outward, into the pinna. The signs and symptoms for herpes zoster oticus are as follows:

• Painful red rashes or herpetic blisters on the eardrum, external ear canal, pinna, the roof of the mouth (palate) or anterior two-thirds of the tongue
• Facial weakness (palsy) or ipsilateral face drop on the same side as the affected ear (resembling Bell's palsy)
• Hearing loss and balance problems
• Ringing in the ears (tinnitus)
• Feeling of spinning or moving
• Loss of taste or change in taste perception

The weakness of the facial nerve indicates a lower motor neurone pattern. A person experiencing any of these symptoms should immediately consult a doctor for an urgent evaluation to prevent long term complications.

Diagnosis and Treatment for Herpes Zoster Oticus

The diagnosis for the herpes zoster oticus depends on the symptoms, like rashes, which appear similar to chickenpox. The antiviral drugs, corticosteroids, or surgical decompression are some of the possibly useful treatments for herpes zoster oticus. Research has shown that the treatment with antiviral medications like famvir (famciclovir), valtrex (valacyclovir) and zovirax (acyclovir) reduces the symptoms for the disease and helps in the recovery. Corticosteroids, like prednisone, valium (diazepam), scopace (transdermal scopolamine patch) or antihistamines such as antivert (meclizine) are often prescribed to reduce vertigo and tinnitus. The symptoms may resolve themselves with time, but some symptoms, like hearing loss or facial paralysis may remain forever.

Although herpes zoster oticus is non contagious, a person with a weak immune system, or a person who has never had chickenpox before, newborns and pregnant women (infection can be dangerous for the developing baby) should avoid contact with the patient. It usually affects people above 60 years age and occurs rarely in children.