August 9, 2023

EDUCATIONAL PEARL

Herpes zoster oticus: Also known as Ramsay Hunt syndrome. A common complication of Shingles, an infection caused by the varicella-zoster virus (VZV). Occurs when the shingles outbreak affects the facial nerves.

Presenting Symptoms:
- Two main signs
  - Painful red rash with fluid-filled blisters on, in and around one ear
  - Facial weakness or paralysis on the same side as the affected ear
- Other symptoms
  - Ear pain
  - Hearing loss
  - Tinnitus
  - Difficulty closing one eye.
  - Vertigo
  - Loss of taste
  - Dry mouth and eyes
Epidemiology:
- Occurs in people who previously had chickenpox. After recovering from chickenpox, the virus remains dormant in the body and can reactivate and manifest as shingles, painful rash with fluid-filled blisters. The shingles outbreak can affect the facial nerve near the ears.
- More common in older adults, specifically people older than 60.
Etiology/Pathophysiology:
- Complication of VZV infection, resulting in inflammation of the geniculate ganglion of cranial nerve VII
Diagnosis:
- Physical examination - look for signs of rash and facial weakness.
- Sample collection of saliva, blood, or fluid for blister sent to pathologist to examine under the microscope for the varicella-zoster virus.
- Imaging test, specifically an MRI.
Treatment:
- Antivirals (eg acyclovir or valacyclovir)
- Corticosteroids (eg prednisone)
- Conservative management for pain, vertigo symptoms

Ramsay Hunt Syndrome. Cleveland Clinic. Accessed 26 July 2023.