Herpes zoster oticus

• 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

Ear findings and facial droop classic for Ramsey Hunt Syndrome.

• 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

• Otoscopy
• Neuro exam focusing on Cranial nerve, crossed findings, upper and lower motor neuron involvement

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

• Outpatient primary care follow-up

• Poor prognostic factors for good functional recovery include[3]
  • age older than 50 years
  • complete facial paralysis
  • lack of CN VII nerve excitability

• Herpes zoster ophthalmicus

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