Herpes zoster oticus is a herpes zoster virus infection of the clusters of nerve cells (ganglia) that control the nerves responsible for hearing and balance (eighth cranial nerve) and for facial movement (seventh cranial nerve).
Herpes zoster (shingles) is an infection that results from a reactivation of the varicella-zoster virus, which causes chickenpox. After an episode of chickenpox, the virus lies dormant in nerve roots and can be reactivated, travelling down the nerve fibers to the skin, where it causes painful sores. Most often the cause of reactivation is unknown, but sometimes it occurs when the immune system is weakened, for example, by cancer, advanced HIV infection, or certain medications.
Herpes zoster oticus occurs when the herpes zoster virus is reactivated in the seventh (facial) and eighth (auditory or vestibulocochlear) cranial nerves. The seventh cranial nerve controls some muscles of the face. The eighth cranial nerve controls hearing and balance.
Symptoms of Herpes Zoster Oticus
The symptoms of herpes zoster oticus include the following:
Severe ear pain
Fluid-filled blisters (vesicles) on the outside of the ear (pinna) and in the ear canal
Temporary or permanent paralysis of one side of the face (similar to Bell palsy)
Vertigo (a false sensation of moving or spinning) that lasts days to weeks
Hearing loss, which may be permanent or which may resolve partially or completely
Rarely, headache, confusion, or a stiff neck
Sometimes other cranial nerves are affected.
Diagnosis of Herpes Zoster Oticus
A doctor's evaluation
Sometimes laboratory tests of fluid from the blisters
Sometimes magnetic resonance imaging (MRI)
Doctors typically diagnose herpes zoster oticus after their evaluation in the clinic. Sometimes doctors take scrapings of the vesicles for examination under a microscope and for culturing. MRI may also be performed to make sure the symptoms are not caused by another disorder.
Treatment of Herpes Zoster Oticus
Sometimes steroids (also called corticosteroids or glucocorticoids), such as prednisone, to reduce inflammationSometimes steroids (also called corticosteroids or glucocorticoids), such as prednisone, to reduce inflammation
Sometimes antiviral medications to treat the infection
Sometimes opioid medications for pain
Rarely surgery to relieve pressure on the facial nerve
Doctors may give people medications to relieve their symptoms and treat herpes zoster oticus. However, it remains uncertain how effective these medications are. Steroids such as prednisone are given to reduce inflammation. Antiviral medications such as acyclovir or valacyclovir may help reduce the duration of the infection and are routinely given to people whose immune system is weakened or impaired. Diazepam is given to relieve the vertigo. Opioids taken by mouth may be given for severe pain.Doctors may give people medications to relieve their symptoms and treat herpes zoster oticus. However, it remains uncertain how effective these medications are. Steroids such as prednisone are given to reduce inflammation. Antiviral medications such as acyclovir or valacyclovir may help reduce the duration of the infection and are routinely given to people whose immune system is weakened or impaired. Diazepam is given to relieve the vertigo. Opioids taken by mouth may be given for severe pain.
Other treatments may be given to people who have prolonged residual pain (called postherpetic neuralgia). These treatments include medicated skin patches, antiseizure medications, and tricyclic antidepressants or other medications used to treat neuropathic pain.
People who have complete paralysis of the face may need a surgical procedure to relieve pressure on the facial nerve.
Prevention of Herpes Zoster Oticus
Vaccination is the primary method recommended for preventing herpes zoster oticus, particularly for adults aged 50 years and older. The recombinant herpes zoster vaccine (RZV) is highly effective in preventing herpes zoster, including herpes zoster oticus. (See Shingles Vaccine for more information.)
