Does treatment of oticus zoster have to take place in hospital?

Due to the serious irreparable damage that is to be feared, zoster oticus treatment should be started in time. It is best to start treatment within the first three days after the first symptoms have become apparent. Zoster oticus is a diagnosis that justifies hospitalization. In other words, this means that the zoster oticus treatment described below should be performed in hospital.

Complications of a Zoster oticus

If the symptoms of zoster oticus are not taken seriously and the disease is not adequately treated, hearing loss is imminent, which can lead to complete deafness. Peripheral fascial nerve palsy is also a complication of zoster oticus. In peripheral fascial nerve palsy, the muscles responsible for facial expression are weakly or even completely paralyzed on one half of the face.

Wrinkling of the forehead is also no longer possible on the side where the VII cranial nerve (nervus facialis) is impaired in its function. In addition, the following is noticeable as an expression of peripheral facial nerve paresis:

An incomplete eyelid closure,
An incomplete mouth closure and/or
A hanging corner of the mouth.

The inner ear or the vestibulochlear nerve can also be affected. This can lead to ringing in the ears, hearing loss up to deafness, vertigo, nausea and nausea.

Other affected cranial nerves may be: trigeminal nerve, abducens nerve, hypoglossal nerve and vagus nerve. Symptoms of irritation of the vagus nerve are hiccups (singultus) and dysphagia. Symptoms of affection of the trigeminal nerve are sensitivity disorders (sensibility disorders) and there is a risk of injury to the conjunctiva (conjunctivis), cornea (cornea) and also the optic nerve (optic nerve), which can lead to visual impairment.

The special form in which the first branch of the trigeminal nerve is affected is called zoster ophtalmicus because of the involvement of the eye. In addition, postzosteric neuralgia can occur. This is a chronic pain syndrome that occurs in 10-15% of patients.

In the area of the spread of zoster, the patient has pain that lasts for four weeks or reoccurs again. The duration is indefinite, the pain is excruciating, it can even lead to suicide. The probability that the neuralgia will persist for a long time increases with age.

This can be months or even years. Meningitis, which causes the varicella zoster virus (zoster encephalitis), or generalization (zoster generalisatus) are also serious complications. Zoster generalisatus refers to an entire infestation of the nervous system.

This type of zoster is life-threatening, but usually occurs only in people who have a weakened immune system (e.g. AIDS patients). Infection with the varicella zoster virus can also cause the embryo to die during pregnancy. Facial nerve palsy is a facial paralysis and can have various causes, although it is often caused by a preceding zoster oticus.

Since in the case of oticus zoster, the facial nerve can be affected by reinfection by the viruses, damage to the nerve can occur, resulting in facial paralysis. Facial nerve palsy is characterized by a drooping corner of the mouth, lack of eyelid closure, and lack of frowning on the affected side. However, it can also be only weakly pronounced, so that a change can only be seen on closer inspection.A facial nerve paresis usually occurs only temporarily or can be reduced in its extent.

In 80% of cases, however, healing occurs. The risk that facial palsy does not heal increases with age. Therefore, it is important to identify and treat zoster oticus quickly in order to prevent such late effects as facial nerve palsy. If facial palsy occurs, it can be treated with glucocorticoids and virustatics. In addition, physiotherapy should be performed afterwards so that the affected muscles can be trained again.