Herpes zoster oticus; Ramsay Hunt syndrome type 2

Etiology

• Herpes zoster spread from the pinna ear

* does not spread from thoracic dermatomes

Pathology

• involvement of cranial nerve VII & cranial nerve VIII

Clinical manifestations

• cranial nerve VII
  • vesicular rash on pinna ear
    • initially, deep burning pain of the ear
    • vesicular eruption of the external auditory canal & concha generally occurs a few days after onset of pain
    • may be drainage of clear fluid from affected ear
  • ipsilateral facial paralysis (Bell's palsy)
  • loss of taste on anterior 2/3 of tongue
    • burning pain on ipsilateral 1/2 of tongue
• cranial nerve VIII
  • vertigo
  • sensorineural hearing loss (ipsilateral)
    • Weber test lateralizes towards the contralateral ear
  • tinnitus
  • horizontal-torsional nystagmus
    • increases looking to the contralateral direction
    • decreases looking to the ipsilateral direction
• dry mouth
• dry eyes

* images

Management

• referral to ENT
• acyclovir (Zovirax) 200 mg 5 times per day
• high-dose glucocorticoids
• amitriptyline (Elavil) 75 mg QHS

More general terms

• Herpes zoster (shingles)
• vestibular disorder (vestibulopathy)
• Ramsay-Hunt syndrome

Additional terms

• dyssynergia cerebellaris myoclonica; Ramsay-Hunt syndrome type 1; Ramsay-Hunt cerebellar syndrome