Zoster Oticus

By | June 10, 2022

Zoster oticus is a secondary disease associated with the varicella-zoster virus. The symptoms appear in the ear region.

What is zoster oticus?

Zoster oticus is a special form of shingles (herpes zoster). This means an infectious disease in the course of which inactive herpes viruses in the ganglia of the central nervous system (CNS) become active again. About 90 percent of the population contract the varicella-zoster virus. For human immunodeficiency virus definition and meaning, please visit howsmb.com.

The initial infection occurs in the form of chickenpox (varicella). You then have immunity to chickenpox that lasts for the rest of your life. However, around 20 percent of all patients can later develop shingles. People over the age of 40 are particularly affected. In some cases, shingles is accompanied by zoster oticus. There are no differences between men and women.


Zoster oticus is triggered by the varicella-zoster virus. This is also known as 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 affects 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 takes place by droplet infection. After the initial infection with chickenpox, the triggering viruses migrate along the nerve fibers into the spinal ganglia. There they can survive and are only activated again years or even decades later.

Because larger areas of the spinal ganglia are destroyed during reactivation, this 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 immune system due to age or immunosuppression, in which the immune system is specifically reduced as part of a transplantation.

Diseases of the immune system such as AIDS ( HIV ) can also result in a disturbed immune system. Other conceivable triggers are toxic substances, serious infections such as rabies, UV rays or X-rays. In addition, the varicella-zoster virus can be transmitted to people who have not yet had chickenpox.

Symptoms, Ailments & Signs

Zoster oticus becomes noticeable in the early stages through tiredness, headaches and body aches. A typical symptom of the disease is the appearance of blisters on the earlobes. They also appear in the external auditory canal and sometimes in the inner eardrum.

Sometimes they are also found on the tongue, soft palate and sides of the throat. The vesicles are the size of a pinhead or a grain of rice. The water-clear tense and plump bubbles resemble pearls. They appear as a sharply defined reddening of the skin and appear within two to three days.

After a period of two to seven days, the blister contents take on a yellowish purulent color while the redness slowly subsides. After the blisters have dried up after about a week, a yellowish or brownish crust develops. The illness lasts about two to three weeks and then goes away. It is not uncommon for scarring to appear in the form of light or dark patches of skin.

The so-called zoster pain shows up during the disease inside the ear, in the neck or in the side region of the face. About two thirds of all patients also suffer from facial paralysis on one side of the face. The corners of the mouth droop, the eyelid cannot be closed completely and the forehead cannot be wrinkled.

Diagnosis & course of disease

In order to be able to diagnose zoster oticus, the doctor pays attention to the patient’s symptoms. Redness and blistering on the ear are typical signs. Further investigations are only required in problem cases. It is also possible to identify the causative agent.

This process takes place via polymerase chain reaction from the contents of the vesicles or from affected tissue. Furthermore, it is possible to detect specific antibodies to the pathogen, but this is not considered to be particularly meaningful because the virus is already present in the body.

In most cases zoster oticus takes a positive course. Two-thirds of all patients heal without problems. Relapses are very rare. However, in people over the age of 60, the disease can last for a long time. The course of the disease is considered to be unfavorable if people with immune deficiency are affected by zoster oticus.


Zoster oticus can cause various complications in the course. Typical secondary symptoms include headaches and body aches. Most patients also develop blisters on their earlobes, which can become inflamed. If the bubbles spread to the inner eardrum, hearing problems and temporary deafness can occur. When the blisters appear on the tongue or gums, it causes problems with eating.

This can result in malnutrition with its typical complications and consequences. If the blisters are scratched open, this can lead to the formation of scars. The so-called zoster pain accompanies these symptoms.

This characteristic pain in the face and neck area increases as the disease progresses and is accompanied by visual field defects such as drooping corners of the mouth. Major complications are unlikely when treating zoster oticus. Problems can arise if the person affected is allergic to proven drugs such as valaciclovir or brivudine.

In addition, side effects and interactions can occur, for example in individual cases there are depressive moods or physical complaints such as headaches and body aches and gastrointestinal problems. Severe complications require hospital treatment.

When should you go to the doctor?

If the sufferer suffers from unexplained tiredness, a general feeling of illness or weakness, there is cause for concern. If these irregularities persist for several days or if they increase in intensity, a doctor should be consulted. In the event of body aches, a decrease in physical performance and diffuse exhaustion, it is advisable to consult a doctor. Changes in the appearance of the skin and in particular blistering on the face are signs of a disease.

Since zoster oticus is a viral disease, the pathogens can multiply unhindered in the body if left untreated and trigger an increase in symptoms. If blisters form in the ear or mouth, it is advisable to consult a doctor.

The sooner medical care can be initiated, the better the healing path will be and complications can be avoided. There is a need for action if there are complaints in the area of ​​the face or neck. If pain or visual disturbances occur, consult a doctor immediately. Internal weakness, emotional changes due to the visual blemish, and reddening of the skin should be evaluated and treated. In many cases, there is a rapid change in the appearance of the skin within a few hours.

Treatment & Therapy

The treatment of zoster oticus is antiviral. It is important to start treatment no later than 72 hours after the onset of skin symptoms. Aciclovir is usually administered, which can be administered in the form of tablets or as an infusion. Other proven agents are valaciclovir, famciclovir and brivudine, which also belong to the antivirals.

These active ingredients fight the growth and multiplication of herpes viruses by working against the structure of the virus DNA. After just a few hours, skin symptoms and pain are successfully suppressed. To treat the pain, the patient receives painkillers, anticonvulsants such as gabapentin or antidepressants. Tricyclic antidepressants are particularly useful in the case of zoster neuralgia. In case of severe complications, hospital treatment is required.


Vaccination against chickenpox is considered the most sensible preventive measure against zoster oticus. If the chickenpox does not break out, zoster oticus cannot develop later. The chickenpox vaccination is one of the standard vaccination procedures for children and adolescents.


Follow-up care for zoster oticus includes what has already been said about self-help: A healthy lifestyle helps the patient to support the immune system so that it can counteract a new outbreak of the infection. This is important because the varicella-zoster virus has taken root in the body and is still latent in the body even after an outbreak has been fought successfully.

If the immune system becomes weaker – be it due to other serious diseases such as cancer, increasing age, therapies that suppress the immune system or infections such as influenza or gastrointestinal diseases, then the zoster virus has it easy again Break out. Patients are therefore advised to limit their alcohol consumption and to abstain from nicotine altogether.

A balanced, fresh diet is indispensable for the immune system, as is physical exercise in the fresh air, which trains the heart and circulation. In the case of nutrient deficiencies, the administration of appropriate dietary supplements helps. Patients should consult their GP on this. In Germany, vaccines against shingles have been available 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 this vaccination, especially if the patient is over fifty years old.

You can do that yourself

In most cases, major complications only occur with zoster oticus if the immune system is very weak. It is therefore particularly important for the 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 the patients avoiding stimulants such as alcohol and nicotine, but eating a balanced diet, making sure they have extended rest periods and exercising as much as possible in the fresh air. It is also recommended to drink one and a half to two liters of still water every day, as it supports the work of the excretory organs and helps to eliminate toxins.

During the acute phase of zoster oticus, the painful blisters of zoster oticus can make it difficult for people to eat. But especially in immunocompromised patients, this can quickly lead to malnutrition. It is particularly important for them to eat a fresh, balanced diet. If these patients are unable 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 can develop depressive moods. In this case, the doctor will prescribe an antidepressant. Psychotherapeutic crisis intervention is also conceivable.

Zoster Oticus