Zoster oticus
Last Updated: 2019-08-26
ICD11: -
Last Updated: 2019-08-26
Author(s): Anzengruber F., Navarini A.
ICD11: -
Ramsay Hunt syndrome, ear zoster, herpes zoster of the ear.
Herpes zoster infection in the auricle and surrounding area. The Hunt's zone includes the auricle, the tympanic membrane and the external auditory canal. In the case of involvement of the facial nerve and the vestibulocochlear nerve, dizziness, tinnitus and possibly also hearing loss, we speak of Ramsay-Hunt syndrome.
Diagnosis by the ENT physician!
Facial paralysis occurs in about 50-60% of cases.
Some sources recommend a short-term administration of oral glucocorticoids (prednisolone 50 mg daily p.o.) in addition to antiviral therapy.
Topical Therapy
Different local therapies depending on the clinic.
According to current guidelines, therapy with topical local anaesthetics is not recommended.
Tannosynt®-Lsg. several times a day
Iod-Povidon®sg. several times daily
System therapy
acyclovir (Zovirax®)
Application: 10-15 mg/kg bw/d i.v.
Contraindication: hypersensitivity, breastfeeding (because of transfer to breast milk)
Side effects (very common): headache, nausea
In older patients there is an increased risk of reversible neurological disorders.
Adjustment of dosage for reduced kidney function.
Sufficient liquid supply.
Valaciclovir (Valtrex®)
Application: 1g 3x/d for 7d
Contraindication: Hypersensitivity, lactation.
Side effects (frequent): headache, nausea.
Adjustment of dosage for reduced kidney function.
Famciclovir (Famvir®)
Application: 500 mg 3x/d for 7 days (10 days with immunosuppression)
Independent of meals.
Drug interaction: Probenecid.
Contraindication: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir.
Patients at risk of dehydration, especially older patients, should pay attention to adequate hydration.
Efficacy in black patients may be reduced.
Foscarnet (Foscavir®)
Application: 3 x 40 mg/kg bw/d intravenously
Side effects (very common): granulocytopenia, anorexia, hypokalemia, hypomagnesemia, hypocalcaemia, paresthesia, headache, dizziness, nausea, vomiting, diarrhea, rash, increased serum creatinine, fever, fatigue, chills, asthenia.
Adjustment of dosage for reduced kidney function.
enough fluid intake.
Prednisolone
Recommendation according to current guidelines.
Application: 0.5-1.0 mg per kg bw for 7-10 days
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 1: Diagnosis. J Eur Acad Dermatol Venereol 2017;31:9-19.
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 2: Treatment. J Eur Acad Dermatol Venereol 2017;31:20-29.
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 1: Diagnosis. J Eur Acad Dermatol Venereol 2017;31:9-19.
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 2: Treatment. J Eur Acad Dermatol Venereol 2017;31:20-29.
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