Herpes zoster oticus: Difference between revisions
(16 intermediate revisions by 6 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Also know as " | *Also know as "Ramsay Hunt syndrome" | ||
* | *Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle, or mucous membrane of the oropharynx | ||
*Associated facial paralysis usually involving CN VII but may involve CN VIII | *Associated facial paralysis usually involving [[Cranial nerve palsies|CN VII]] but may involve [[Cranial nerve palsies|CN VIII]] | ||
**geniculate ganglion: movements of the facial muscles, sensation of parts of the ear and ear canal, taste function of the tongue, and lubrication of the eyes and oral mucosa | **geniculate ganglion: movements of the facial muscles, sensation of parts of the ear and ear canal, taste function of the tongue, and lubrication of the eyes and oral mucosa | ||
**vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo | **vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo | ||
Line 8: | Line 8: | ||
==Clinical Features== | ==Clinical Features== | ||
*URI symptoms common for 1-3 days prior | [[File:Ramsey Hunt Syndrome.png|thumb|Ear findings and facial droop classic for Ramsey Hunt Syndrome.]] | ||
*Paroxysmal pain deep within ear: radiates outward into the pinna of the ear<ref>Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011</ref> | *[[URI]] symptoms common for 1-3 days prior | ||
*Paroxysmal [[earache|pain]] deep within ear: radiates outward into the pinna of the ear<ref>Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011</ref> | |||
**Usually precedes the rash by several hours and even days | **Usually precedes the rash by several hours and even days | ||
**Erythema and Swelling of auricle | **Erythema and Swelling of auricle | ||
Line 17: | Line 18: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Facial paralysis}} | |||
{{Ear DDX}} | {{Ear DDX}} | ||
== | {{VZV types}} | ||
==Evaluation== | |||
*Otoscopy | *Otoscopy | ||
*[[Neuro exam]] focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement | *[[Neuro exam]] focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement | ||
Line 30: | Line 30: | ||
==Management== | ==Management== | ||
''Most effective when started within 3 days of symptom onset'' | ''Most effective when started within 3 days of symptom onset'' | ||
*Oral [[analgesia]] | |||
*[[Antiviral]] Options<ref>Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008</ref> | |||
**[[Acyclovir]] 800mg 5 times a day x 7 days | |||
**[[Famciclovir]] 500mg TID x 7 days | |||
**[[Valacyclovir]] 1000mg TID x 7 days | |||
*[[Prednisone]] 60mg qday x 7 days | |||
==Disposition== | ==Disposition== | ||
*Outpatient | *Outpatient primary care follow-up | ||
==Prognosis== | ==Prognosis== | ||
Line 47: | Line 47: | ||
==See Also== | ==See Also== | ||
*[[Herpes | *[[Herpes zoster ophthalmicus]] | ||
==Video== | |||
{{#widget:YouTube|id=YxjhX9lHe_g}} | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Dermatology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Neurology]] | ||
[[Category:ENT]] |
Revision as of 16:29, 3 February 2020
Background
- Also know as "Ramsay Hunt syndrome"
- Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle, or mucous membrane of the oropharynx
- Associated facial paralysis usually involving CN VII but may involve CN VIII
- geniculate ganglion: movements of the facial muscles, sensation of parts of the ear and ear canal, taste function of the tongue, and lubrication of the eyes and oral mucosa
- vestibulocochlear nerve is close to the geniculate ganglion, patients may complain of tinnitus, hearing loss, and vertigo
- Caused by herpes zoster
Clinical Features
- URI symptoms common for 1-3 days prior
- Paroxysmal pain deep within ear: radiates outward into the pinna of the ear[1]
- Usually precedes the rash by several hours and even days
- Erythema and Swelling of auricle
- Vesicles within external ear canal and on auricle
- Facial pain
- Develop over 3-7 days
Differential Diagnosis
Facial paralysis
- Bell's palsy
- CVA
- Trigeminal neuralgia
- Tick paralysis
- Herpes zoster oticus (Ramsay Hunt syndrome)
- CNS tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannoma
- Parotid
- Sarcoma
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Varicella zoster virus
- Varicella (Chickenpox)
- Herpes zoster (Shingles)
- Herpes zoster ophthalmicus
- Herpes zoster oticus (Ramsay Hunt syndrome)
Evaluation
- Otoscopy
- Neuro exam focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement
Management
Most effective when started within 3 days of symptom onset
- Oral analgesia
- Antiviral Options[2]
- Acyclovir 800mg 5 times a day x 7 days
- Famciclovir 500mg TID x 7 days
- Valacyclovir 1000mg TID x 7 days
- Prednisone 60mg qday x 7 days
Disposition
- Outpatient primary care follow-up
Prognosis
- Poor prognostic factors for good functional recovery include[3]
- age older than 50 years
- complete facial paralysis
- lack of CN VII nerve excitability
See Also
Video
{{#widget:YouTube|id=YxjhX9lHe_g}}
References
- ↑ Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011
- ↑ Uscategu T. et al. Antiviral therapy for Ramsay Hunt syndrome in adults. Cochrane Database Syst Rev. 2008
- ↑ Ryu EW, Lee HY, Lee SY, Park MS, Yeo SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otolaryngol. Nov 8 2011