August 9, 2023

EDUCATIONAL PEARL

Herpes zoster oticus: Also known as Ramsay Hunt syndrome. A common complication of Shingles, an infection caused by the varicella-zoster virus (VZV). Occurs when the shingles outbreak affects the facial nerves.

  • Presenting Symptoms: 

    • Two main signs 

      • Painful red rash with fluid-filled blisters on, in and around one ear 

      • Facial weakness or paralysis on the same side as the affected ear 

    • Other symptoms 

      • Ear pain 

      • Hearing loss

      • Tinnitus 

      • Difficulty closing one eye. 

      • Vertigo 

      • Loss of taste 

      • Dry mouth and eyes 

  • Epidemiology: 

    • Occurs in people who previously had chickenpox. After recovering from chickenpox, the virus remains dormant in the body and can reactivate and manifest as shingles, painful rash with fluid-filled blisters. The shingles outbreak can affect the facial nerve near the ears. 

    • More common in older adults, specifically people older than 60.  

  • Etiology/Pathophysiology: 

    • Complication of VZV infection, resulting in inflammation of the geniculate ganglion of cranial nerve VII

  • Diagnosis: 

    • Physical examination - look for signs of rash and facial weakness.

    • Sample collection of saliva, blood, or fluid for blister sent to pathologist to examine under the microscope for the varicella-zoster virus. 

    • Imaging test, specifically an MRI. 

  • Treatment: 

    • Antivirals (eg acyclovir or valacyclovir) 

    • Corticosteroids (eg prednisone)

    • Conservative management for pain, vertigo symptoms

Ramsay Hunt Syndrome. Cleveland Clinic. Accessed 26 July 2023. 
 

Further Readings: 

NIH Stat Pearls – Ramsay Hunt Syndrome 

Written by: Alexandria Bao