Zoster oticus

Ramsay Hunt syndrome, ear zoster, herpes zoster of the ear, Ramsay Hunt syndrome.

Herpes zoster infection on the auricle and surrounding area. Hunt's zone includes the auricle, the tympanic membrane and the external auditory canal. Involvement of the facial nerve and the vestibulocochlear nerve, dizziness, tinnitus and possibly also hearing loss is referred to as Ramsay-Hunt syndrome.

Diagnosis by the ENT doctor!

Facialis paralysis occurs in about 50-60% of cases.

• About 1/3 of all patients remain deaf in the ear
• Some sources recommend short-term administration of oral glucocorticoids (prednisolone 50 mg p.o. daily)
in addition to antiviral therapy
• Presentation to ENT specialist

• Light protection
• HNO medical presentation

Topical therapy

• Different local therapies depending on the clinic
• Current guidelines do not recommend therapy with topical local anaesthetics.
• Tanning agents several times a day
• Fusidic acid cream several times a day
Fusidic acid + betamethasone cream several times a day
• Iodine-povidone solution several times a day

System therapy

Aciclovir

• Add.: 10-15 mg/kg bw/d i.v.
• KI: hypersensitivity, lactation (as transfer to breast milk)
• SNW (very common): headache, nausea
• CAVE:
  • In elderly patients, there is an increased risk for the occurrence of reversible neurological disorders
  • Adjust dosage if renal function is impaired
  • Enough fluid intake

Valaciclovir

• Add.: 1g 3x/d for 7d
• CI: Hypersensitivity, lactation
• ADVERSE REACTIONS (common): headache, nausea
• CAVE:
  • Adjustment of dosage in impaired renal function
  • Hydration state

Famciclovir

• Add: 500 mg 3x/d for 7 days (10 days in immunosuppression)
• Independent on meals
• WW: probenecid
• CI: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir
• CAVE:
  • In patients at risk of dehydration, especially elderly patients, adequate hydration should be ensured
  • Efficacy may be reduced in black patients

Foscarnet

• In immunosuppression and aciclovir resistance
• Administration: 3 x 40 mg/kg bw/d i.v.
• KI: hypersensitivity, pregnancy, lactation
• SNW (very common): granulocytopenia, anorexia, hypokalaemia, hypomagnesaemia, hypocalcaemia, paraesthesias, headache, dizziness, nausea, vomiting, diarrhoea, rash, increased serum creatinine, fever, fatigue, chills, asthenia
• CAVE:
  • Adjust dosage if renal function is impaired
  • Enough fluid intake

Prednisolone

• Recommendation according to current guidelines
• Dose: 0.5-1.0 mg per kg bw for 7-10 days

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14. 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.

15. 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.

16. 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.

17. 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.