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Herpetic Otitis Externa

  1. Organism
    H. simplex
    H. zoster
  2. Vesicles on TM, meatal skin, concha and post aural groove
  3. VII, VIII + G nerves may be involved
  4. Features of H-zoster/Ramsay Hunt syndrome = Herpes zoster oticus
  5. Site of affection
    1. Geniculate ganglion of the facial nerve
    2. May also involve the IX & X cranial nerves
  6. Symptoms:
    1. Severe otalgia
    2. Vesicular eruptions on the pinna of the affected ear
    3. Facial nerve palsy (LMN type). when this happens it is called Ramsay Hunt syndrome
    4. May show associated vesicular eruptions in the buccal mucosa, hard palate and hypopharynx
    5. ± Anesthesia of face/giddiness/H. loss-* due to involvement of V and VIIIth nerve
  7. Treatment:
    1. Oral acyclovir (to be started within 72 hrs of the onset of rash) Dose: 800mg 5x/day ± steroids
    2. Post - herpetic neuralgia (panic persists months/year after the rashes have disappeared)
  8. Treatment: Tricylic Antidepressants

MCQ . Sluder’s neuralgia. It is characterised by neuralgic pain in lower half of face with nasal congestion, rhinorrhoea and increased lacrimation. It is due to neuralgia of sphenopalatine ganglion.
Correct is: sliders neuralgia: anterior ethmoidal nerve

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