Symptoms

Usually the first symptoms of zoster oticus are undefined symptoms such as fatigue and tiredness. The vesicles characteristic of herpes zoster are found in zoster oticus on the pinna, on the earlobe, in the depth of the external auditory canal and also on the eardrum. They can also occur laterally on the neck, tongue and soft palate.

The vesicles are pinpoint to rice grain size, water clear, tight and pearly. They form on a previously developed, slightly raised and sharply defined skin redness (erythema) within two to three days. After two to seven days, the content of the blisters becomes purulent yellowish and the redness subsides.

After one week, the blisters dry out and a brownish-yellowish crust forms. After about two to three weeks the shingles heal again.However, scarring is common, resulting in dark or light spots on the skin where the blisters were previously (hyper- and hypopigmentation). Caution: The reactivation of the varicella zoster virus can also take place without any symptoms of the skin, which is called herpes zoster sine herpete.

The so-called zoster pain has already been described above. It can occur in the ear, on the side of the face or on the neck. In 2/3 of patients suffering from oticus zoster, peripheral facial nerve palsy occurs in the first or second week of the disease, caused by the virus infecting the facial nerve.

This leads to a weak or complete paralysis of the mimic muscles on one side of the face. Patients are unable to frown the forehead on the affected side, eyelid closure is not or only incompletely possible and the corners of the mouth hang down. Facial nerve palsy is often accompanied by a hemiplegic taste disorder and impaired salivary secretion.

Facial nerve palsy can also occur with zoster colli. Early signs of a developing zoster oticus can be unspecific general symptoms such as Also dull, pulling pain usually stresses the patient even before the visible skin symptoms. These are added over the course of about three days and initially appear as a simple rising redness.

Subsequently, the blisters fill with a clear liquid. Sooner or later the blisters open, dry out and become encrusted. Within two to three weeks the skin symptoms should have subsided, assuming they have occurred at all.

Exhaustion,
Tiredness,
Headache and aching limbs

The pain and blisters characteristic of shingles (herpes zoster) usually occur in the area of the upper body. Occasionally, however, this symptom can also be found in the area of the head. If the above-average pain and vesicles occur in the area of the auricle and/or the external auditory canal, it is called zoster oticus.

Scars or pigmentation disorders of the skin can remain if a secondary infection of the area has occurred, i.e. an additional infection, for example with a bacterium, has occurred. A so-called zoster gangraenosus can also cause scarring, since in the course of the zoster gangraenosus, skin death (necrosis) occurs. After more or less successful healing of the skin symptoms, the pain may persist as a zoster oticus symptom.

This is called post-herpetic neuralgia. Ear pain, hearing loss or pathological hypersensitivity to sounds of normal loudness (hyperacusis) may also accompany the above-mentioned symptoms as symptoms of zoster oticus. In addition, the sense of balance may be affected.

This can manifest itself for example with vomiting and vertigo. It is important for the diagnosis to look at the patient’s clinical symptoms, as the vesicles and redness in the area of the ear are characteristic of oticus zoster. Further diagnosis is usually only necessary in problem cases.

The pathogen can be detected. The direct virus detection is done by polymerase chain reaction (PCR) from affected tissue or vesicle contents. The PCR is a method for amplifying the viral DNA, if it is present in the samples.

Specific antibodies against the virus can also be detected in the body. However, this is not very meaningful, that Zoster oticus is a reactivation of a virus already present in the body, i.e. the antibodies could have already been produced by the body’s defence system during the initial infection with chickenpox. The cerebrospinal fluid of the brain and spinal cord (cerebrospinal fluid) has inflammatory changes, i.e. many more cells of the defense system and proteins can be found than are normally found in the fluid.

The cerebrospinal fluid is obtained by a lumbar puncture. A hollow needle is inserted into the spinal canal in the spine and cerebrospinal fluid is removed. Under the microscope (blood smear), giant multinucleated cells can be found in the blood.

The blisters on the skin, which are typical for herpes zoster, can also be an untypical sign of an infection with herpes simplex virus. This form of herpes simplex that mimics zoster is also known as “zosteriform herpes simplex”.Conversely, an irregularly localized zoster can also mimic a herpes simplex infection as a “herpetiformer zoster”. The clinical picture of eczema herpeticatum includes, like the zoster oticus, vesicles arranged in groups, but they burst very soon.

Eczema herpeticatum is caused by an additional herpes simplex infection in the presence of an existing chronic skin disease. Blistering also occurs in Hailey-Hailey disease. In this skin disease, blisters form due to a congenital cornification disorder of the skin. Acute zoster pain can be similar to the pain of a blood clot in the lung (pulmonary embolism), a heart attack, appendicitis or migraine.