Ear shingles and Ramsay Hunt syndrome are not the same. Although both diseases are caused by the varicella zoster virus, Ramsay Hunt syndrome is a complication of ear herpes zoster. What are the symptoms of herpes zoster and what are the symptoms of Ramsay Hunt syndrome? What is the treatment?
Ear shinglesandRamsay Hunt syndromeare not the same. Shingles in the ear is caused by the varicella zoster virus ( varicella zoster virus- VZV), which occurs in 10-20% of patients. people in the population. It occurs in 150-300 out of 100,000 people, and its frequency increases especially after the age of 60.
Ramsay Hunt syndrome is a rare complication of herpes zoster, which is caused by the reactivation of a latent VZV infection in the facial nerve knee ganglion (VII nerve). It occurs in 5 out of 100,000 people and is characterized by peripheral paralysis of the VII nerve with damage to the VIII nerve and hearing impairment.
Herpes zoster - causes and risk factors
The cause of the disease is the varicella zoster virus ( varicella zoster virus- VZV). After childhood chickenpox, the virus that causes this disease does not disappear from the body, but enters the spinal ganglia, where it may remain hidden for many years. It reactivates in some patients when the immune system is weakened (such as in the elderly), causing shingles. A characteristic rash can appear on the skin of the auricle, in the external ear canal and on the eardrum - it is called shingles.
The risk factors for shingles neuralgia, apart from the patient's age, are also:
- diabetes
- cancer
- coexistence of diseases affecting the patient's immunity
Herpes zoster - symptoms
- foci of follicles (filled with serous fluid, 1-2 mm in size) on the erythematous surface of the auricle. After about 7-14 days, the vesicles may develop scabs with an umbilical depression in the middle, then the lesions may peel or scar
- earache - within the auricle
- dizziness
- chills
- fever
Ramsay Hunt syndrome - symptoms
Complication of shinglesof the ear is Ramsay-Hunt syndrome, in the course of which the above-mentioned symptoms are joined by:
Ear herpes zoster is associated with severe earaches, a vesicular rash involving the auricle. Coexistence of facial paralysis or paresis with dizziness and deafness is known as Ramsay-Hunt syndrome.
- vesicles on the erythematous substrate not only on the auricle, but also on the palate or part of the tongue
- peripheral paresis or paralysis of the facial nerve (VII cranial nerve) and / or vestibulocochlear (VIII cranial nerve):
- closing the eyelid fissure of the left eye - visible, clear facial asymmetry - falling left corner of the mouth - smoothing of the forehead skin (inability to wrinkle it) - reduced sensation and paresthesia within the facial skin
In the most severe - stage VI of paralysis - complete paralysis of the damaged side of the facial nerve, lack of facial movements, muscle tonus, compassion and contractures. The patient has difficulty in activities such as expressing surprise, clenching the eyelid gap, smiling, blowing, grinning and whistling
- tinnitus
- hearing loss
- nystagmus
- changes in the perception of taste
- nausea, vomiting
Apart from the VII nerve, other cranial nerves (V, IX, X) may be involved.
Worth knowingRamsay Hunt syndrome can be confused with Bell's palsy
This syndrome is often misdiagnosed, especially since no skin lesions are found in about 10% of patients. This variety, known as Ramsay Hunt syndrome sine herpete, must be distinguished from the most common cause of facial nerve palsy - Bell's palsy. Unlike Ramsay Hunt's syndrome, there are no lesions in the skin of the external auditory canal, and the symptoms of facial nerve paresis are more severe and have a worse prognosis.
Ear shingles andRamsay Hunt syndrome - treatment
General treatment (antiviral medicine - acyclovir, painkillers) and local treatment (antiviral and antibacterial ointments, warm compresses) are used. Some recommend the inclusion of glucocorticosteroids that have anti-swelling and anti-inflammatory effects. As a result, the skin changes disappear, but the symptoms of facial nerve paresis and hearing loss may still persist.
Early diagnosis is essential to initiate appropriate therapy that can reduce the inflammation of the facial nerve and lead to a faster healing. Antiviral treatmentmust be taken within 72 hours. It limits the development of infections, prevents the formation of new skin lesions and affects the disappearance of existing ones, and also reduces the severity of pain.
Source:
1. Baran A., Chodynicka B., Ear shingles and its complications. Ramsay Hunt syndrome. Description of three cases, "Review of dermatology" 2011
2. Grabowska j., Ankudowicz A., Ankudowicz G., Ear shingles in a child in the form of Ramsay Hunt syndrome - case report, "Przegląd Dermatologiczny" 2016
Shingles: Causes and Symptoms
Shingles is a viral disease caused by the varicella zoster virus. Shingles is most common in adulthood, but it is also sporadic in children. What are the symptoms of shingles, who is susceptible to shingles, and what causes the activation of the virus?