eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpes Zoster Oticus: Follow-up

Author: Christina Bloem, MD, Assistant Clinical Professor of Emergency Medicine, George Washington University
Coauthor(s): Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center; Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Nov 4, 2008

Follow-up

Further Inpatient Care

  • For patients with herpes zoster oticus, consider admission for any of the following situations:
    • Severe symptoms
    • Involvement of multiple (>2) dermatomes
    • Immunocompromise

Further Outpatient Care

  • Ensure that the patient has adequate and timely outpatient follow-up for management of HZ oticus.
  • Consultation with an ear, nose, and throat (ENT) specialist may be appropriate.

Complications

Complications of herpes zoster oticus may include the following:

Prognosis

  • Prolonged or permanent facial paralysis (possible)
  • Most patients with partial paralysis fully recover; many with severe symptoms are left with partial deficits.

Patient Education

  • Instruct patients how to tape eyes shut if lid paralysis is present.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize a central cause of facial paralysis
  • Failure to recognize and treat ocular complications
  • Failure to identify immunoincompetence
 


More on Herpes Zoster Oticus

Overview: Herpes Zoster Oticus
Differential Diagnoses & Workup: Herpes Zoster Oticus
Treatment & Medication: Herpes Zoster Oticus
Follow-up: Herpes Zoster Oticus
References

References

  1. Furuta Y, Ohtani F, Mesuda Y. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology. Sep 12 2000;55(5):708-10. [Medline].

  2. Murakami S, Honda N, Mizobuchi M. Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Neurology. Oct 1998;51(4):1202-5. [Medline].

  3. Whitley RJ, Weiss H, Gnann JW. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. Sep 1 1996;125(5):376-83. [Medline].

  4. Wood MJ, Johnson RW, McKendrick MW, Taylor J, Mandal BK, Crooks J. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. Mar 31 1994;330(13):896-900. [Medline].

  5. Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. Jul 16 2008;CD006852. [Medline].

  6. Benson CA, Kaplan JE, Masur H. Treating opportunistic infections among HIV-exposed and infected children: recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. MMWR Recomm Rep. Dec 17 2004;53(RR-15):1-112. [Medline].

  7. Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology. Feb 2008;115(2 Suppl):S13-20. [Medline].

  8. Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jun 6 2008;57:1-30; quiz CE2-4. [Medline].

  9. Adour KK. Otological complications of herpes zoster. Ann Neurol. 1994;35 Suppl:S62-4. [Medline].

  10. Bauer CA, Coker NJ. Update on facial nerve disorders. Otolaryngol Clin North Am. Jun 1996;29(3):445-54. [Medline].

  11. Murakami S, Hato N, Horiuchi J. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment. Ann Neurol. Mar 1997;41(3):353-7. [Medline].

  12. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry. Aug 2001;71(2):149-54. [Medline].

Further Reading

Keywords

herpes zoster oticus, HZ oticus, viral infection of the ear, Ramsay Hunt syndrome, facial paralysis, varicella-zoster virus, VZV, reactivation of varicella-zoster virus, reactivation of VZV, postherpetic neuralgia, otalgia, hearing loss, vertigo

Contributor Information and Disclosures

Author

Christina Bloem, MD, Assistant Clinical Professor of Emergency Medicine, George Washington University
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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