Herpes zoster oticus, also referred to as Ramsay Hunt Syndrome or ear shingles, is a viral condition. It results from the reactivation of the varicella-zoster virus, the same pathogen responsible for chickenpox, and typically manifests as a painful rash. While the exact causes of these outbreaks are unclear, a weakened immune system is a significant contributing factor.
Ramsay Hunt Syndrome occurs when the herpes zoster virus affects the facial and cranial nerves, particularly the ones responsible for hearing and balance. This virus lies dormant in the nerve roots after an initial bout of chickenpox but can reactivate when the immune system weakens. It travels along the nerves, causing an inflammation that leads to painful sores. These sores, resulting from burst vesicles, eventually crust over and heal. This rash with small blisters around and inside the ear often indicates shingles in the ear, known as herpes zoster oticus.
Ramsay Hunt Syndrome symptoms include:
This condition typically starts as a burning pain under the skin, days before the appearance of blisters. However, it is also characterised a feeling of fatigue, fever and itching and heightened sensitivity in the affected area.
Herpes zoster oticus can theoretically break out in anyone who has had chickenpox. As soon as a person becomes infected with the varicella-zoster virus (VZV) for the first time, the first thing they do is get chickenpox. Once a person has caught the chickenpox, the virus stays in the body and withdraws into the spinal ganglia (into the nerve cell bodies along the spinal cord). There it can remain inactive until it is reactivated. A reactivation can be triggered by a weakened immune system. Age or the suppression of the body's own immune system, such as that caused by HIV, can be the causes of a fluctuating or weakened immune system. X-rays, UV rays or contact with toxic substances can also be the trigger.
The diagnosis of ear shingles is typically straightforward as it involves a physical examination that identifies symptoms indicative of herpes zoster oticus, such as vesicles and redness in the ear and its surrounding area. Further diagnostic tests are rarely required and are usually reserved for the more unusual and complex cases. However, if there is any doubt, the doctor may opt to analyse the fluid secreted from the vesicles or examine the cerebrospinal fluid.