Rumsay Hunt Syndrome
Definition
Zoster oticus is a secondary disease caused by the Varicella zoster virus in the area of the ears. It is a special form of shingles (herpes zoster).
Introduction
An infection with the varicella zoster virus is the first disease to cause chickenpox. Since the virus remains in the body of the infected person for a lifetime, reactivation of the virus can lead to a second disease, shingles, in about 20% of infected persons. Shingles is mainly found in the upper part of the body. Occasionally, the pronounced pain and blisters characteristic of shingles can also occur in the area of the auricle and/or the external auditory canal. In this case one speaks of the so-called Zoster oticus.
Is a Zoster oticus contagious?
As in shingles, the trigger for zoster oticus is the varicella zoster virus, which belongs to the group of herpes viruses. Since zoster oticus is only a reactivation of the virus that is fixed in the nerve cells, the risk of infection is not as high. In zoster oticus, the viruses are found only in the vesicles of the rash. Since the vesicle fluid containing the virus is nevertheless contagious, direct contact with it should be avoided. Although a vaccination against the virus is available, even vaccinated people can develop zoster oticus.
Epidemiology
More than 90% of the population is infected with the varicella zoster virus and falls ill with chickenpox (varicella) on initial infection. Afterwards, they have lifelong immunity against chickenpox. Up to 20% of the partial immune system, mostly adults over 40 years of age, later develop shingles, which can be associated with zoster oticus. In about 2/3 of those who suffer from zoster oticus, the viruses attack the facial nerve, a cranial nerve, which leads to paralysis of the mimic muscles (facial paresis). There are no gender differences.
Pathogen
The Varicella zoster virus is also called human herpes virus-3 and belongs to the group of herpes – viruses that can cause disease. It has a double-stranded DNA with a lipid envelope and occurs worldwide. It preferentially attacks nerve cells and can survive for years in nerve nodes in the spinal canal (spinal ganglion).
It is transmitted by droplet infection. Initial infection with the varicella zoster virus leads to chickenpox. Zoster oticus develops when reinfected with the virus or through reactivation of the actually inactivated viruses in the body.
These viruses migrate along nerve fibers into spinal ganglia, where they survive and can only be reactivated after years or decades. During reactivation, a larger part of the spinal ganglia is destroyed, which leads to acute pain, also known as zoster pain. Reactivation can be triggered by fluctuations or a drop in immunity to the virus due to age, suppression of the body’s own defense system (immunosuppression), for example in transplant patients, or disruption of the defense system (immune deficiency), for example in HIV-infected patients (AIDS).
Possible causes are also violent vibrations of certain parts of the body, X-ray radiation, UV rays, contact with toxic substances or other infectious diseases such as rabies. The virus can be transmitted from people suffering from shingles to unprotected people who then get chickenpox. Similarly, a child with chickenpox can transmit the virus to an adult who then gets shingles.
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