Related articles: Herpes zoster oticus
Definition
Herpes zoster oticus is a disease caused by the reactivation of varicella-zoster virus (VZV), latent at the level of the cranial nerve ganglia (such as the geniculate ganglion of the facial nerve and the ganglia of the eighth cranial nerve). Risk factors include immunodeficiency secondary to cancer, chemotherapy, radiotherapy and HIV infection.
Most common symptoms and signs *
- Tinnitus
- Tinnitus
- ageusia
- Dry mouth
- dysgeusia
- Neck pain
- Temperature
- Tingling in the head
- Swelling around the ear
- Hearing loss
- hypomimia
- Swollen lymph nodes
- Headache
- Meningitis
- Otalgia
- Eye dryness
- Confusional state
- Dizziness
- blisters
Further indications
Herpes zoster oticus occurs mainly with severe ear pain and transient or permanent facial paralysis, with no facial motility (similar to Bell's palsy). The involvement of the vestibular-cochlear structures causes dizziness and hearing loss.
On the skin of the auricle and in the external auditory canal, along the distribution of the sensory branch of the facial nerve, a vesicular eruption appears; within a week or so, the vesicles develop into scabs.
Other symptoms of herpes zoster oticus include pre- and retroauricular lymphadenopathy, asthenia, hyperpyrexia, loss of taste in the front part of the tongue, dry eyes and jaws. In some patients, some degree of meningeal inflammation or mild generalized encephalitis (with symptoms such as headache, confusion and stiff neck) may be found.
The diagnosis is usually clinical. If there is any doubt about the viral etiology, material from the vesicles can be collected for a search of the VZV antigen by direct immunofluorescence assay. Contrast magnetic resonance imaging, on the other hand, allows us to detect a suffering of the facial nerve. In herpes zoster oticus it is possible to use corticosteroids and antiviral drugs.
If facial paralysis is complete, surgery to reduce compression of the facial nerve may be indicated.
