Herpes Zoster Otikus

09JANHerpes Zoster Otikus adalah infeksi virus pada telinga dalam, telinga tengah dan telinga luar. HZO

manifestasinya berupa otalgia berat yang disertai dengan erupsi kulit biasanya pada CAE dan pinna.

Bila disertai dengan paralisis n VII maka disebut sebagai Ramsay Hunt Syndrome. Patofisiologi :

merupakan reaktifasi dari varicella-zoster virus (VZV) yang terdistribus sepanjang saraf sensoris yang

menginervasi telinga, termasuk didalamnya ganglion genikulatum. Apabila gejala disertai kurang

pendengaran dan vertigo, maka ini adalah akibat penjalaran infeksi virus langsung pada N. VIII pada

posisi sudut serebelo pontin, atau melalui vasa vasorum. Anamnesis disertai riwayat : nyeri dan

terasa panas pada sekitar telinga, wajah, mulut dan lidah. Vertigo, nausea, muntah. Kurang

pendengaran, hiperakusis, tinitus. Rasa sakit pada mata, lakrimasi. Vesikel bisa muncul sebelum,

selama maupun sesudah terjadinya paralisis n VII.

Perlu ditanyakan riwayat pernah terkena cacar air sebelumnya, bahkan saat masih kecil. Terapi :

sampai saat ini sifatnya hanya suportif misalnya kompres hangat analgetik narkotika dan antibiotika

untuk mencegah sekunder infeksi. Sebenarnya antivirus memberikan efek yang baik yaitu penyakit

menjadi tidak terlalu berat dan cepat membaik.

A 28-year-old Asian man presented to the Ben Taub General Hospital with right facial hemiparesis, a

varicelliform rash in his right conchal bowl and lateral external auditory canal, and severe right otalgia.

He described a gradual onset of right otalgia followed by right conchal bowl erythema and edema

three days before presentation. He began having dry mouth and decreased taste over the right side of

his tongue just prior to the development of the rash. The rash and facial nerve palsy were noted

simultaneously. He had no complaints of dizziness, vertigo, or tinnitus but did have decreased hearing

in the right ear. There was no past history of varicella infection. Physical examination revealed a thin

Asian man with stable vital signs and no fever. A rash composed of vesicles of different ages filled the

conchal bowl and lateral external auditory canal. The tympanic membrane had no lesions and the

chorda tympani nerve could not be seen. Minimal forehead movement and near complete eye closure

were noted with no other facial motor function on the right side. Otologic examination was normal on

the left. The remainder of the neurological examination was without abnormality. Schirmer testing

revealed bilaterally symmetrical tearing to 2 centimeters.

Audiometric analysis showed mild sensorineural hearing loss to 2000 Hz on the right side with

moderate sensorineural loss above 4000 Hz bilaterally. No crossed stapedial reflex could be elicited

on the left. The tympanogram was type A on the left and type B on the right.