Herpes Zoster Oticus (8th Cranial Nerve)

Herpes Zoster of the 8th Cranial Nerve, i.e. reactivated Varicella Zoster Virus (VZV), can present as Ear Pain and/or Vertigo.
Easy to Dx if symptoms are accompanied by:
  • Unilateral facial palsy (VZV may overlap CN 7 & 8)
  • Vesicles on external ear or in ear canal
  • Combined Ear Pain and Vertigo

If Dx secure & pt <50 y.o., order HIV test (any zoster is common in HIV)

If no telltale findings as above, it mimics Acute Labyrinthitis
  • Sudden onset vertigo, often nausea/vomiting
  • Hearing loss, tinnitus
  • Need to R/O Stroke (see Acute Labyrinthitis)

See posting Vertigo – 2.