HERPES ZOSTER OTICUS

DEFINITION:

Herpes Zoster Oticus is defined as a herpetic vesicular rash on the concha , EAC  or pinna with LMN palsy of the ipsilateral Facial nerve.

WHAT ARE THE DIFFERENT POSSIBLE SITES FOR VZ-PARTICLES TO RESIDE DORMANT?

1. Geniculate ganglion of Facial Nerve
2. Spiral and vestibular ganglia of VIII Nerve

WHAT IS THE POSSIBILITY OF VIRUS TO BE PRESENT IN CONCHA?

• 100 % if vesicles present.
• 71 % if no initial skin lesion but develop vesicles within a week.

WHAT ARE THE SYMPTOMS OF INVOLVEMENT OF VIII NERVE?

1. Hearing loss
2. Tinnitus
3. Vertigo

WHAT PERCENT WILL HAVE SUBJECTIVE HEARING LOSS?

• 25 % of children
• 50 % of adult

WHAT IS ZOSTER SINE HERPETE?

• It is the condition with a Facial palsy but without cutaneous or mucosal rash along with a rise in serological titres or presence of Zoster DNA in the skin confirming the viral aetiology.
• It causes 3 % of facial palsy.

WHAT PERCENTAGE OF FACIAL PALSY IS CAUSED BY HERPES ZOSTER?

• 18 %
• It is the second most common cause of Facial Palsy after idiopathic Bell’s Palsy.

WHAT IS THE RECOVERY RATE OF FACIAL PALSY AFTER HERPES ZOSTER INFECTION?

1. ACYCLOVIR + PREDNISOLONE if started within 3 days of onset of symptoms : 70 % recovery
2. If started on or after day 8: 30 % (Murkami’s et al)

WHAT IS THE ROLE OF USING ANTIVIRAL IN HZ INFECTION?

• It reduces the prevalance of the post-herpetic neuralgia
• If early treatment is started the the chances of complete recovery increases.

WHAT ARE THE LOCATION FOR RASHES?

1. Concha
2. EAC
3. Pinna
4. Mouth
5. Pharynx

WHAT ARE THE PROGNOSTIC FACTORS FOR RECOVERY?

1. Initiation of Treatment:  Early treatment (within 3 days of onset) results in good recovery.
2. Types of Facial Nerve Palsy:  Incomplete Facial palsy recovers more : 60%
3. AGE:  Elderly has poor recovery.

WHAT PERCENTAGE OF CASES WILL DEVELOP A COMPLETE FACIAL PARALYSI WITHIN A WEEK ?

• 60 %

HOW DOES HERPES ZOSTER OTICUS DIFFER FROM BELL’S PALSY IN NATURAL HISTORY?

1. Bells palsy recurs in 12 % of cases but HZ rarely recur.
2. In Bell’s palsy the decrease in respose to electrical testing peaks in 5-10 days but in HZ , the peak is later (10-14 days).
3. 84% of cases of Bell’s Palsy have satisfactory recovery while only 60% of HZ has satisfactory recovery.

WHAT ARE THE DIFFERENT TYPES OF RAMSAY HUNT SYNDROME?

• Ramsay Hunt syndrome type 1, also called Ramsay Hunt cerebellar syndrome, is a rare form of cerebellar degeneration which involves myoclonic epilepsy, progressive ataxia, tremor, and a dementing process.
• Ramsay Hunt syndrome type 2 is the reactivation of herpes zoster in the geniculate ganglion. It is sometimes called herpes zoster oticus, and has variable presentation which may include a lower motor neuron lesion of the facial nerve, deafness, vertigo, and pain. A triad of ipsilateral facial paralysis, ear pain, and vesicles on the face, on the ear, or in the ear is the typical presentation.
• Ramsay Hunt syndrome type 3 is a less commonly referenced condition, an occupationally induced neuropathy of the deep palmar branch of the ulnar nerve. It is also called Hunt’s disease or Artisan’s palsy