Zoster oticus

Last Updated: 2019-08-26

Author(s): Anzengruber, Navarini

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.

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

  • Introduction to ENT specialist 
  • Light protection.
  • Otorhinolaryngologist's presentation.

 

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 

  • Fucidine® cream several times a day 
    Fucicort® cream 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 

  • CAVE:
  • 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.

  • CAVE:
  • Adjustment of dosage for reduced kidney function.

  • Hydration state. .

 

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.

  • CAVE:
  • Patients at risk of dehydration, especially older patients, should pay attention to adequate hydration.

  • Efficacy in black patients may be reduced.

 

Foscarnet (Foscavir®)

  • for immunosuppression and acyclovir resistance 
  • Application: 3 x 40 mg/kg bw/d intravenously 

  • Contraindication: hypersensitivity, pregnancy, lactation.
  • Side effects (very common): granulocytopenia, anorexia, hypokalemia, hypomagnesemia, hypocalcaemia, paresthesia, headache, dizziness, nausea, vomiting, diarrhea, rash, increased serum creatinine, fever, fatigue, chills, asthenia.

  • CAVE:
  • 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

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