Guidelines

The so-called guidelines are principles or courses of action by which doctors can orient themselves. The clinical picture, diagnostics and recommended therapies are contained in them. Since zoster oticus is a special form of shingles and can take on serious courses, the guidelines can help to identify it correctly and to treat it.

The guidelines strongly recommend that all patients with oticus zoster begin antiviral therapy. Therapy is necessary because zoster oticus affects the nerves that are responsible for hearing, i.e. cranial nerves VII and VIII. Patients with zoster oticus can therefore become deaf or hard of hearing if no therapy is given.

It is therefore important to diagnose zoster oticus correctly. According to the guidelines, the diagnosis is also made mainly by the clinical picture. For the specific diagnosis to check the hearing ability a so-called tone threshold audiometry can be performed.

After the vesicles have dried up, disinfectant ointments are applied which kill off pathogens (antiseptic). Zoster oticus must be treated antivirally. The therapy should be started no later than 72 hours after the appearance of the skin symptoms.

In most cases, acyclovir is used, especially if it is a severe, complicated form of zoster oticus. It can be administered orally, i.e. in tablet form, or intravenously by infusion. Brivudine, Famciclovir or Valaciclovir can also be used as oral therapy.

The drugs mentioned above belong to the group of antivirals. These are active substances that specifically counteract the growth and multiplication of the herpes virus. They inhibit the structure of the virus – DNA.

The antiviral therapy often leads to freedom from pain and improvement of the skin symptoms within hours. Painkillers (analgesics), antidepressants or drugs for epilepsy (antiepileptic drugs) such as gabapentin can be taken to relieve zoster pain. In zoster neuralgia, tricyclic antidepressants such as amitriptyline usually help best.

So-called antiviral drugs are used for treatment. These are drugs that stop the reproduction of viruses. Preparations that can be considered for systemic therapy in people with an intact immune system (immunocompetent patients) are Famciclovir, Valaciclovir and Brivudin are administered orally, i.e.

by mouth, whereas Aciclovir can either be taken orally or administered intravenously, i.e. into a vein. Intravenous administration is preferable to oral administration because of the higher levels of the active ingredient that can build up in the organism. With regard to the effect on skin symptoms, the above mentioned drugs are equivalent.

However, studies have shown that Famciclovir, Valaciclovir and Brivudin are faster in combating pain associated with zoster oticus. In childhood and adolescence only Aciclovir may be used. People whose immune system is weakened or suppressed (immunocompromised patients) are also given only acyclovir in the vein.

In immunocompromised patients older than 25 years of age, oral administration of Famciclovir may also be considered. Furthermore, due to the usually severe pain, the patient should be given local anaesthetic ear drops to prevent the pain from becoming permanent in the future. Antibiotic ear drops should also be considered as part of local treatment, as there is a possibility of bacterial superinfection, i.e. additional infection with a bacterium.

Aciclovir,
Famciclovir,
Valaciclovir and Briduvin.

There are many different homeopathic remedies for zoster oticus, which are recommended at certain stages. For example, the affected person should take sulfur at the beginning, before the blisters appear. However, since a zoster oticus is usually only noticeable by a general feeling of illness or by pain in the area of the future rash, this phase is rather difficult to grasp.

If the vesicles are there and rather pus-filled, the intake of Anagallis arvensis is recommended. If the vesicles are clear, Rhus toxicodendron should be taken. In case of severe rashes and severe pain Rhus vernix is taken. In the post-treatment, especially if the zoster oticus subsequently causes pain although the rash has healed, it is recommended to take Kalmia latifolia.