Zoster oticus is a secondary disease with the varicella-zoster virus. In this case, the symptoms appear in the ear region.
What is zoster oticus?
Zoster oticus represents a special form of shingles (herpes zoster). It refers to an infectious disease in the course of which inactive herpes viruses become active again in the ganglia of the central nervous system (CNS). Varicella zoster virus affects about 90 percent of the population. The initial infection occurs in the form of chickenpox (varicella). Immunity to chickenpox then lasts for the rest of the patient’s life. However, around 20 percent of all patients can later contract shingles. People over 40 years of age are particularly affected. In some cases, shingles is accompanied by zoster oticus. There are no differences between men and women.
Causes
Zoster oticus is caused by the varicella zoster virus. This also bears the name human herpes 3 virus. It belongs to the group of herpes viruses. The pathogen, which occurs worldwide, is equipped with a double-stranded DNA including a lipid envelope. The varicella zoster virus primarily attacks nerve cells. The germ is able to survive in the nerve nodes of the spinal canal for a period of several years. Transmission to humans occurs through droplet infection. After initial infection with chickenpox, the causative viruses travel along the nerve fibers into the dorsal root ganglia. There they can survive and are reactivated only after years or even decades. Because reactivation results in the destruction of larger spinal ganglia areas, it results in acute pain, also known as zoster pain. Possible reasons for reactivation of the virus are disorders of the immune system, a reduction in the strength of the defense system due to age, or immunosuppression, in which the immune system is deliberately lowered as part of a transplant. Likewise, diseases of the immune system such as AIDS (HIV) can result in a disturbed immune system. Other conceivable triggers are toxic substances, severe infections such as rabies, UV radiation or X-rays. In addition, transmission with the varicella-zoster virus is possible to
People who have not yet contracted chickenpox is possible.
Symptoms, complaints, and signs
Zoster oticus is noticeable in the early stages by fatigue and headache and pain in the limbs. The appearance of vesicles on the earlobes is considered a typical symptom of the disease. They also appear in the external auditory canal and sometimes in the internal eardrum. Sometimes they also occur on the tongue, soft palate and side of the throat. The vesicles reach the size of a pinhead or a grain of rice. The water-clear tense and plump vesicles resemble pearls. They show up on a sharply demarcated redness of the skin and emerge within two to three days. After a period of two to seven days, the vesicle contents take on a yellowish purulent color while the redness slowly subsides. After the vesicles dry out after about a week, a yellowish or brownish crust appears. The disease lasts about two to three weeks and then recedes. It is not uncommon for scarring to appear in the form of light or dark skin patches. The so-called zoster pain appears during the disease within the ear, in the neck or in the lateral facial region. About two thirds of all patients also suffer from facial paresis on one side of the face. In this case, the corners of the mouth droop, the eyelid cannot be completely closed, and frowning is not possible.
Diagnosis and course of the disease
To diagnose zoster oticus, the doctor pays attention to the patient’s symptoms. The redness as well as the formation of vesicles on the ear are considered typical signs. Only in problem cases, further examinations are then required. It is also possible to detect the causative pathogen. This is done by polymerase chain reaction from the contents of the vesicles or from affected tissue. Furthermore, detection of specific antibodies of the pathogen is possible, but this is not considered to be particularly informative because the viruses are already present in the body anyway. In most cases, zoster oticus takes a positive course. Thus, healing proceeds without problems in two-thirds of all patients.Relapses occur only very rarely. In people over 60 years of age, however, the disease can persist for a longer period of time. The course of the disease is considered unfavorable when people with immunodeficiency are affected by zoster oticus.
Complications
Zoster oticus can cause various complications during its course. Typical secondary symptoms include headache and pain in the limbs. Most patients also experience blisters on the earlobes, which can become infected. If the vesicles spread to the inner eardrum, hearing difficulties and temporary deafness may occur. If the vesicles appear on the tongue or palate, this causes problems with food intake. This may result in malnutrition with its typical complications and consequences. If the vesicles are scratched open, this can lead to the formation of scars. Accompanying these symptoms is the so-called zoster pain. This characteristic pain in the face and neck area increases in the course of the disease and is accompanied by visual field deficits such as drooping corners of the mouth. Major complications are unlikely with treatment of zoster oticus. Problems can occur if the affected person is allergic to established agents such as valaciclovir or brivudine. In addition, side effects and interactions can occur; for example, in individual cases, depressive moods or physical complaints such as headaches, aching limbs, and gastrointestinal problems occur. Severe complications require hospital treatment.
When should you see a doctor?
If the affected person suffers from unexplained fatigue, a general feeling of illness or faintness, there is cause for concern. If these irregularities persist unabated for several days or increase in intensity, a physician should be consulted. In case of pain in the limbs, a decrease in physical performance as well as diffuse fatigue, consultation with a physician is advisable. Changes in the appearance of the skin and, in particular, the formation of blisters on the face are signs of the disease. Since zoster oticus is a viral disease, the pathogens can multiply unhindered in the organism in an untreated state and trigger an increase in symptoms. If vesicles form in the area of the ear or in the mouth, consultation with a physician is recommended. The sooner medical care can be initiated, the better the healing process and complications can be avoided. If there are complaints in the area of the face or neck, action is required. If pain or visual disturbances occur, a physician should be consulted immediately. Any internal weakness, emotional changes due to the visual blemish, and redness of the skin should be investigated and treated. In many cases, there is a rapid change in the appearance of the skin within a few hours.
Treatment and therapy
Treatment of zoster oticus is antiviral. It is important to start treatment no later than 72 hours after the onset of skin symptoms. Aciclovir, which can be administered in tablet form or as an infusion, is usually administered. Other proven agents are valaciclovir, famciclovir and brivudine, which also belong to the group of antivirals. These active ingredients combat the growth and reproduction of herpes viruses by acting against the structure of the viral DNA. Skin symptoms and pain are successfully suppressed after just a few hours. To treat the pain, the patient is given painkillers, anticonvulsants such as gabapentin or antidepressants. Especially in case of zoster neuralgia, tricyclic antidepressants are considered useful. In case of severe complications, hospital treatment is required.
Prevention
Vaccination against chickenpox is considered the most useful preventive measure against zoster oticus. If chickenpox does not break out, zoster oticus cannot occur later. Chickenpox vaccination is one of the standard vaccination procedures for children and adolescents.
Follow-up
Aftercare for zoster oticus includes what has already been said about self-care: Patients are helped by a healthy lifestyle to support the immune system so that it can counteract a new outbreak of the infection. This is important because the varicella-zoster viruses have taken up residence in the body and are still latent even after an outbreak has been successfully controlled.If the immune system now becomes weaker – whether due to other serious illnesses such as cancer, increasing age, therapies that suppress the immune system, or infections such as flu-like infections or gastrointestinal diseases – then the zoster viruses have an easy time breaking out again. Patients are therefore advised to limit their alcohol intake and to avoid nicotine altogether. A balanced, fresh diet is essential for immune defense, as is physical exercise in the fresh air, which exercises the heart and circulation. In the case of nutrient deficiencies, the administration of appropriate dietary supplements helps. Patients should consult their family doctor about this. Vaccines against shingles have been available in Germany for some time. These also protect against a zoster oticus outbreak, since both shingles and zoster oticus are triggered by the same herpes viruses. Most health insurance companies reimburse for this vaccination, especially if patients are over the age of fifty.
What you can do yourself
In most cases, zoster oticus only leads to major complications if the immune system is very weak. Therefore, it is especially important for affected patients to ensure a stable immune system. This is especially true for people over the age of sixty. The immune system is positively stimulated by patients abstaining from stimulants such as alcohol and nicotine, but instead eating a balanced diet, taking care to get extended periods of rest and exercising as much as possible in the fresh air. It is also advisable to drink one and a half to two liters of still water daily, as this supports the excretory organs in their work and helps to eliminate harmful substances. During the acute phase of zoster oticus, the painful vesicles of zoster oticus can make it difficult for patients to eat. However, especially in immunocompromised patients, this can quickly lead to malnutrition. For them, it is especially important to pay attention to a fresh, balanced diet. If these patients find it impossible to eat three to five times a day, they should inform their doctor. He may try to compensate for any deficiencies with dietary supplements or artificial nutrition. During the disease phase, the patient may experience depressive moods. In this case, the doctor will prescribe an antidepressant. Psychotherapeutic crisis intervention is also a possibility.