Herpes zoster oticus (HZO) is one of the clinical syndromes which develops after the initial colonization of varicella virus in the ganglia of the cranial nerves [1] [2]. Defined as an infection of the ear that appears after reactivation of VZV from the geniculate ganglion, this clinical entity is now a rare occurrence in clinical practice, and is predominantly encountered among elderly individuals [1] [3] [4]. The clinical presentation comprises of a typical rash in the form of erupting vesicles in the external auditory canal, the eardrum, pinna, and cavum conchae, whereas otalgia (ear pain that is described as severe), tinnitus, vertigo, and even hearing impairment are reported [1] [2] [4] [5] [6]. Higher frequencies are more severely affected than lower frequencies, and in a number of patients, hearing loss can be severe enough to result in deafness [4] [5]. Paresis of the facial nerve on the ipsilateral side (manifesting as unilateral facial paralysis and asymmetry of the face) quite often accompanies the typical features of herpes zoster oticus and the term Ramsay Hunt syndrome (named after the first physician who described the condition) is used for this condition in the literature [2] [5] [6]. Other notable symptoms are nausea, vomiting, nystagmus, and distribution of lesions in the oral cavity, while pain may spread throughout the face and neck area [1] [2].

• Pain

  Some patients also find that they require additional pain relief medications to cope with the severe pain associated with the syndrome. [thailandmedical.news]

  Shingles occurs in people who have had chickenpox and in whom the varicella-zoster virus becomes active again. [1] Herpes zoster oticus is caused by the spread of the virus to facial nerves and can cause intense ear pain; a rash around the ear, mouth, [rarediseases.info.nih.gov]

  Postherpetic neuralgia (pain due to nerve fiber damage by the virus) may also develop and persist for months to years. [medicinenet.com]

  A pain reliever to reduce pain. A variety of possible medications to relieve symptoms of vertigo. An anti-seizure medicine, such as carbamazepine, to treat persistent pain (postherpetic neuralgia). [my.clevelandclinic.org]

  Sometimes strong painkillers are also needed if the pain continues even with steroids. [nlm.nih.gov]

• Fever

  On hospital day three, she developed fever; antibiotics were switched to ampicillin and cefepime. [afmr.org]

  It is usually a concomitant of fever, but may also develop in situations of other stresses without fever or prior illness. The virus is carried by most people but usually lies quiescent. [medical-dictionary.thefreedictionary.com]

  After a few days, shivering and fever (39°C) developed. During hospitalization peripheral facial paralysis was observed. [termedia.pl]

  Clinical Presentation: Patients with Ramsay Hunt syndrome typically present with fever, malaise, tinnitus, vertigo, nystagmus, hearing loss, peripheral facial nerve palsy, and a painful vesicular rash with burning blisters around the ear and on the face [ajnr.org]

• Swelling

  Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. [ncbi.nlm.nih.gov]

  The intraoperative swelling of facial nerve was determined by the extension of swelling beyond facial canal or the degree of bulging through the incision in the nerve sheath. [doi.org]

  On exam, she had a left-sided cranial nerve VII palsy, swelling of the left pinna and inner ear canal, with mild erythema and swelling of the left auricle. [jetem.org]

  An imaging scan, such as an MRI, may reveal swelling of the facial nerves. Scans can also help the doctor determine whether the virus has reached the brain or other nerves. [medicalnewstoday.com]

  The virus is thought to infect the facial nerve that is located near the inner ear, which leads to irritation and swelling in the area. [thailandmedical.news]

• Falling

  […] the eardrum, ear canal, earlobe, tongue, and roof of the mouth on the side with the affected nerve Hearing loss on one side Sensation of things spinning ( vertigo ) Weakness on one side of the face that causes difficulty closing one eye, eating (food falls [nlm.nih.gov]

  […] ear canal, earlobe, tongue, and roof of the mouth on the side where there is weakness of the face Hearing loss on one side Sensation of things spinning ( vertigo ) Weakness on one side of the face that causes difficulty closing one eye, eating (food falls [nicklauschildrens.org]

• Asymptomatic

  Once developed, they may be used to help with prevention or minimize initial infections as well as treatment for existing infections. [ 40 ] Antivirals Antivirals may reduce asymptomatic shedding; it is believed asymptomatic genital HSV-2 viral shedding [enacademic.com]

  HSV asymptomatic shedding occurs at some time in most individuals infected with herpes. [ipfs.io]

  New HCV infections are usually asymptomatic. Some persons get acute hepatitis which does not lead to a life-threatening disease. [who.int]

  Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19 M. Gandhi et al. Transforming ORs into ICUs A.W. Peters et al. Rural Matters — Coronavirus and the Navajo Nation H. [nejm.org]

  In asymptomatic patients, sensitivity can be increased with phonation, deep breathing or gasping. 9 The differential diagnosis between laryngeal paralysis and fixation as such, can be complex. [elsevier.es]

• Pertussis

  Tetanus, diphtheria, pertussis: Booster doses of tetanus-diptheria (Td) are needed at 10-year intervals. [publichealth.va.gov]

  Bacterial agents such as Bordatella pertussis and Mycoplasma are causative agents for bronchitis. In these cases, the occurrence of purulent cough is not a significant diagnostic factor of Pneumonia. [athena.targetwoman.com]

• Nausea

  Other symptoms may include hearing loss, vertigo (feeling that the room is spinning), tinnitus (hearing abnormal sounds), nausea, vomiting, loss of taste in the tongue, and dry mouth and eyes. [1] [2] Some cases of herpes zoster oticus do not require [rarediseases.info.nih.gov]

  […] 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 If no telltale findings as above, it mimics Acute Labyrinthitis Sudden onset vertigo, often nausea [diagnosisdude.com]

  Other notable symptoms are nausea, vomiting, nystagmus, and distribution of lesions in the oral cavity, while pain may spread throughout the face and neck area. With a thorough clinical workup, herpes zoster oticus can be easily diagnosed. [symptoma.com]

  J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. [ncbi.nlm.nih.gov]

  If the nearby cochlear and vestibular nerves become involved, patients may also experience hearing loss, tinnitus, nausea, vomiting, and vertigo. [timeofcare.com]

• Visual Impairment

  Involvement of the trigeminal nerve may cause visual impairment up to blindness (herpes zoster opthalmicus), while involvement of the facial and vestibulocochlear nerves can cause facial paralysis and hearing loss ( herpes zoster oticus ). [amboss.com]

• Excessive Tearing

  Central nervous system examination revealed only pain in the area of the vesicles on the right side of the face, there was excessive tears from the right eye, pain and tingling sensation in the right side of the face along the vesicular lesions, mild [biopublisher.ca]

• Vesicular Rash

  A 28-year-old woman with systemic lupus erythematous and dermatopolymyositis treated with immunosuppressive drugs, now with diffuse painful vesicular rash and right-sided facial nerve paralyses, hearing loss, and vestibular ataxia View Case [ajnr.org]

  On Otological examination, we noticed multiple vesicular rashes on the left Pinna, Pre-auricular and Post-auricular region and the external auditory canal. The tympanic membrane on the left side was congested. [medresearch.in]

  Subsequent reactivation of latent VZV can result in localized vesicular rash, known as herpes zoster. [edoj.org.eg]

• Skin Lesion

  Herpes zoster cranial neuropathy (or polyneuropathy) without skin lesions, subcategorized by the cranial nerves involved. Group 3. [medlink.com]

  The systemic and topical treatment led to healing of skin lesions. In one case, facial palsy and partial hearing loss persisted. Conclusions. [termedia.pl]

  The skin lesion was improved during his hospitalization period. Facial palsy was completely cured after 2 months of treatment. [ncbi.nlm.nih.gov]

  The systemic and topical treatment led tohealing of skin lesions. In one case, facial palsy and partial hearing losspersisted.Conclusions. [journaldatabase.info]

• Skin Rash

  […] virus=VZV) Herpes Zoster, often known as shingles, is a frequently painful skin rash localized to one region of the body. [ozarkderm.com]

  Results: A 68-year old man with stage IV lung adenocarcinoma, for which he received pemetrexed maintenance chemotherapy, presented to the emergency department with a progressive skin rash despite broad spectrum antibiotics, vertigo, and diminished hearing [tandfonline.com]

  Herpes zoster (shingles Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. [merckmanuals.com]

  The virus can be reactivated and can cause a painful rash in the dermatome area of skin where the virus laid dormant. [dallasear.com]

• Eczema

  Postherpetic geniculate ganglionitis SNOMEDCT: 21954000 – Herpes zoster auricularis Look For Subscription Required Diagnostic Pearls Subscription Required Differential Diagnosis & Pitfalls Allergic contact dermatitis Bullous fixed drug eruption Cellulitis Eczema [visualdx.com]

  […] en Herpes viral infections (herpes simplex dermatitis [ eczema herpeticum ], herpes simplex [ cold sores ], Kaposi s varicelliform eruption en Pharmaceutical preparations with antiviral and/or antimicrobial properties for use in the treatment of herpetic [glosbe.com]

  Eczema herpectium is a generalized eruption caused by herpes infection in children suffering from eczema. Vagbhata Visarpa mainly straps from the affected area with wide spread ulceration. [drchethansblog.blogspot.com]

  […] most striking is the appearance of clean linear erosions in skin creases, with the appearance of a knife cut. [ 8 ] Herpetic sycosis Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicle. [ 9 ] :369 Eczema [enacademic.com]

  One of the most striking is the appearance of clean linear erosions in skin creases, with the appearance of a knife cut. [15] Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicles. [16] :369 Eczema [ipfs.io]

• Tinnitus

  Other symptoms may include hearing loss, vertigo (feeling that the room is spinning), tinnitus (hearing abnormal sounds), nausea, vomiting, loss of taste in the tongue, and dry mouth and eyes. [1] [2] Some cases of herpes zoster oticus do not require [rarediseases.info.nih.gov]

  Other symptoms may include hearing loss, vertigo (abnormal sensation of movement), and tinnitus (abnormal sounds). [ninds.nih.gov]

  Symptoms Rapid onset with facial pain Tinnitus and Vertigo may occur if Cranial Nerve 8 is involved V. Signs Unilateral herpetic rash of pinna Hearing Loss Peripheral facial paralysis VI. [fpnotebook.com]

  This may occasionally be associated with tinnitus, vertigo, deafness, severe otalgia, and inflammation of the pinna. [mesh.kib.ki.se]

  Other symptoms may include hearing loss, vertigo (abnormal sensation of movement), tinnitus (abnormal sounds), taste loss in the tongue, dry mouth, and dry eyes. [sharecare.com]

• Otalgia

  Diagnosis is primarily clinical and is based on a combination of facial palsy, otalgia, and vesicles on the pinna or oral mucosa. [visualdx.com]

  Department of Otolaryngology, College of Medicine, Chosun University, Korea Ramsay Hunt 증후군에 대한 임상적 고찰 전남대학교 의과대학 이비인후과학교실1;조선대학교 의과대학 이비인후과학교실2; ABSTRACT A clinical syndrome which consists of vesicular eruption on the external ear, facial nerve paralysis, otalgia [kjorl.org]

  Common presenting symptoms include cutaneous auricular vesicles, severe otalgia, inflammation of the pinna, and occasionally unilateral sudden facial paralysis. [ncbi.nlm.nih.gov]

  A result of reactivation of varicella-zoster virus infection, it manifests as severe otalgia and associated cutaneous vesicular eruption. Also called Ramsay Hunt Syndrome or Ramsay Hunt Syndrome type II, it is a common complication of shingles. [delveinsight.com]

• Hearing Impairment

  […] of hearing impairment was not significantly different between patients with and without facial palsy. [journals.lww.com]

  In this case, the patient presented with isolated vestibular dysfunctions without facial palsy and hearing impairment, and these findings were confirmed by electrophysiologic studies including video head impulse testing. [koreamed.org]

  The clinical presentation comprises of a typical rash in the form of erupting vesicles in the external auditory canal, the eardrum, pinna, and cavum conchae, whereas otalgia (ear pain that is described as severe), tinnitus, vertigo, and even hearing impairment [symptoma.com]

  Hearing impairment is more severe in patients with vertigo than in those without vertigo in both the high and low frequency ranges, even though the degree of hearing impairment is not significantly different between patients with and without facial palsy [ncbi.nlm.nih.gov]

• Ear Discharge

  There was no history of any ear discharge, convulsion, unconsciousness or weakness in any limb. Patient denies any history of hearing loss. [edoj.org.eg]

  Types of ear infections Ear infections are diagnosed by physical examination and laboratory analysis of pus or discharge. In some cases, CT scans may also be taken. [betterhealth.vic.gov.au]

  Patients with chronic ear discharge, headache, weakness of the limbs, and seizures were excluded from this study. All the children were examined for hearing loss, tinnitus, facial weakness, and vertigo. [ijournalhs.org]

• Lesion of the Pinna

  In 1907, Ramsay Hunt described facial nerve palsy associated with ipsilateral hearing loss and vesicular lesions on the pinna or in the auditory canal. 1 Facial weakness with associated vesicles establishes the diagnosis of Ramsay Hunt syndrome. 3 The [jamanetwork.com]

  Tzanck smears from the pinna lesions revealed giant cells [Figure 4]. [ijournalhs.org]

• Vertigo

  […] between patients with and without vertigo (Fig. 3). [journals.lww.com]

  Most patients with vertigo also had hearing loss (28 of 30), and patients without hearing loss did not have vertigo (19 of 21). [ncbi.nlm.nih.gov]

  Vertigo is sometimes treated with medication as well. The prognosis of herpes zoster oticus is typically good, but in some cases hearing loss or facial paralysis may be permanent. [1] Last updated: 8/19/2016 [rarediseases.info.nih.gov]

  Vertigo may be treated with the drug diazepam Prognosis Generally, the prognosis of herpes zoster oticus is good. However, in some cases, hearing loss may be permanent. Vertigo may last for days or weeks. [ninds.nih.gov]

• Neuralgia

  (From Adams et al., Principles of Neurology, 6th ed, p757) Svenska synonymer Herpes inom huvud-halsområdet — Ramsey Hunt artikulärt syndrom Engelska synonymer Ramsay Hunt Auricular Syndrome — Neuralgia, Geniculate — Geniculate Neuralgia — Geniculate Neuralgias [mesh.kib.ki.se]

  Geniculate Neuralgias Herpes Zoster Auricularis Herpes Zoster Cephalicus Herpes Zoster, Geniculate Herpetic Geniculate Ganglionitides Herpetic Geniculate Ganglionitis Neuralgia, Geniculate Neuralgias, Geniculate Ramsay Hunt Auricular Syndrome Ramsay [decs.bvs.br]

  Geniculate; Geniculate Herpes Zoster; Syndrome, Ramsay Hunt; Neuralgias, Geniculate; Herpetic Geniculate Ganglionitides; Herpes Zoster, Geniculate; Geniculate Neuralgias; Geniculate Neuralgia; Geniculate Ganglionitis, Herpetic; Geniculate Ganglionitides [reference.md]

  Additionally, it has been found to decrease the incidence of postherpetic neuralgia. [clinmedjournals.org]

• Dizziness

  In the presented cases, VZV infection was complicated by facial paralysis and dizziness, partial hearing loss and erysipelas in one patient. [termedia.pl]

  Key Words: Herpes zoster oticus, Vestibular nerve, Vertigo, Dizziness Keywords: Herpes zoster oticus ; Vestibular nerve ; Vertigo ; Dizziness [e-rvs.org]

  However, when we found the aspect of dizziness is a different kind from peripheral vertigo, we thought the dizziness was derived from ocular nervous system lesions that can also be involved by HZO2. [cyberleninka.org]

  Facial palsy recovered slowly but completely as well as dizziness (4 month), but this was not the case with the hearing loss. [bmcinfectdis.biomedcentral.com]

  In the presented cases, VZV infection was complicated byfacial paralysis and dizziness, partial hearing loss and erysipelas in onepatient. [journaldatabase.info]

• Irritability

  The virus is thought to infect the facial nerve that is located near the inner ear, which leads to irritation and swelling in the area. [thailandmedical.news]

  Complications, such as corneal irritation or secondary bacterial infection of the vesicles, should be managed with routine therapies. [slideshare.net]

  As a result of this infection, the facial nerve becomes inflamed and irritated. Hearing loss in the affected ear occurs. Hearing loss is reported in 24.4% of affected children 4. [fr.slideshare.net]

  Special care to prevent corneal injury is needed in patients who cannot close their eye, making it susceptible to foreign body irritation and abnormal drying. [drugtopics.com]

• Paresis

  CONCLUSION: Grading of the facial nerve alone fails to predict the outcome of facial paresis in patients with HZO mainly because it overlooks the involvement of CN VIII. [ncbi.nlm.nih.gov]

  According to the House-Brackmann scale, the patient had paresis (grade IV) of the facial nerve. The patient was treated with intravenous acyclovir, antibiotics and anti-inflammatory drugs. [termedia.pl]

  He separated between 4 forms: 1) herpes zoster without neuralgic signs; 2) herpes zoster oticus with facial paresis; 3) herpes zoster oticus with facial paresis and hearing symptoms 4) Ramsay Hunt syndrome - auricular herpes zoster syndrome. [whonamedit.com]

  Pembahasan: SRH merupakan hasil reaktivasi virus varicella zoster laten diganglion genikulatum yang menyebabkan vesikel pada aurikula, otalgia dan paresis/paralisis fasialis. [medicahospitalia.rskariadi.co.id]

  Multiple cranial nerve involvement is rare in herpes zoster oticus, but when present, appears to worsen prognosis for recovery of facial paresis and hearing loss. [medlink.com]

With a thorough clinical workup, herpes zoster oticus can be easily diagnosed. Firstly, a detailed patient history should assess the presenting complaints, their duration, as well as severity, but the role of a properly conducted physical examination is perhaps of essential importance. A full inspection of the auditory canal and the face is sufficient to identify vesicular rash that is highly suggestive of a VZV infection. Furthermore, if facial paralysis is suspected, a neurological examination including the assessment of cranial nerves will detect features of facial nerve palsy [2]. Weakness of the muscles of facial expression supplied by the facial nerve will manifest as a drooping lower lid, incomplete eye closure, reduced movement of the lip and the forehead, and facial asymmetry [2]. Thus, a combination of clinical findings is usually enough to make the diagnosis of herpes zoster oticus or Ramsay Hunt syndrome, but in some patients, the findings may be nonspecific and microbiological studies should be performed in those cases. Detection of high antibody titers is a useful initial method, but testing of samples obtained from swabs or ear fluid by polymerase chain reaction (PCR) is a highly recommended diagnostic tool that carries a high rate of success [1] [6] [7].

Hearing recovery also tended to be better in patients with early treatment. There was no significant difference in facial nerve outcome between intravenous and oral acyclovir treatment. [ncbi.nlm.nih.gov]

Treatment The first-line treatment for Ramsay Hunt syndrome is usually a short course of corticosteroid medications, such as prednisolone for 5-7 days. [thailandmedical.news]

Prompt diagnosis and treatment (ideally within 72 hours of the onset of symptoms) are crucial to secure the best outcomes. In cases where treatment has been started within this time period, facial weakness recovers in up to 75% of patients. [cochrane.org]

but when treatment is needed, pain medications, antiviral drugs or corticosteroids may be prescribed. [rarediseases.info.nih.gov]

Vertigo may be treated with the drug diazepam Prognosis Generally, the prognosis of herpes zoster oticus is good. However, in some cases, hearing loss may be permanent. Vertigo may last for days or weeks. [ninds.nih.gov]

We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or [ncbi.nlm.nih.gov]

Early diagnosis is an important factor to promote a positive prognosis for the condition. If treatment is commenced within 3 days of the initiation of symptoms, 70% of patients are likely to make a full recovery. [thailandmedical.news]

Ramsayův-Huntův syndrom paralýzy Portuguese Síndrome de Paralisia de Ramsay Hunt Spanish Síndrome de Parálisis de Ramsay Hunt French Paralysie de Hunt German Ramsey-Hunt-Syndrom Italian Sindrome di Ramsay Hunt Norwegian Ramsay Hunts syndrom English Ramsay-Hunt (etiology [fpnotebook.com]

DelveInsight, through its newsletter series, aims for increased awareness about the indication, its underlying causes, etiology, symptoms, and risk factors among its readers. [delveinsight.com]

Etiology Ramsay Hunt syndrome type 2 is caused by reactivation of varicella zoster virus in the geniculate ganglion. Risk Factors Immunocompromised state, lack of varicella vaccination. [eyewiki.aao.org]

If there is any question about viral etiology, vesicular scrapings may be collected for direct immunofluorescence or for viral cultures, and MRI is done to exclude other diagnoses. [msdmanuals.com]

The etiology of facial palsy includes trauma, unknown causes, Human Immunodeficiency Virus infection, 8 iatrogenic causes, tumor, congenital causes, and particularly in Bell's palsy and Ramsay Hunt syndrome, viral infection. [doi.org]

The newsletter is a brief introduction of the indication – Herpes zoster oticus, with its epidemiological analysis, treatment approaches, unmet needs in the market, and upcoming therapies in the pipeline. [delveinsight.com]

Methods: We discuss the epidemiology, diagnosis and treatment of RHS using a case report of a cancer patient who presented with disseminated VZV reactivation, including RHS. [tandfonline.com]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

English: 92 Allowable Qualifiers English: BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology [decs.bvs.br]

Epidemiology, clinical manifestations, and diagnosis of herpes zoster. https://www.uptodate.com/contents/search. Accessed August 25, 2019. AskMayoExpert. Herpes zoster (shingles). Mayo Foundation for Medical Education and Research; 2019. Teresa MO. [mayoclinic.org]

VZV infection or reactivation involving the geniculate ganglion of CN VII within the temporal bone is the main pathophysiological mechanism of Ramsay Hunt syndrome. [medifitbiologicals.com]

Molecular and Systemic Pathophysiology Reactivation of the varicella zoster virus (VZV) along the distribution of the sensory nerves innervating the ear, which usually includes the geniculate ganglion, is responsible for zoster oticus. [link.springer.com]

Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases. Zhu L, et al. Virol Sin. 2014" 4. Harper DM, DeMars LR2. HPV vaccines-A review of the first decade. Gynecol Oncol. 2017;146(1):196-204. 5. [doctoranytime.gr]

Pathophysiology Reactivation of varicella-zoster virus involving the geniculate ganglion is the main cause of Ramsay Hunt Syndrome Type 2. There are three theories on the pathophysiology of the polyneuropathy nature of Ramsay Hunt Syndrome. [eyewiki.aao.org]

Fortunately, there is another vaccine, Zostavax, which is helpful in preventing viral reactivation. Consequently, shingles and Ramsay Hunt syndrome can be either prevented or their symptoms reduced if the vaccine is administered. [medicinenet.com]

Prevention Prevention of Ramsay Hunt Syndrome Vaccinations for chickenpox (for children) and for shingles (for adults over 60) greatly reduce your chance of developing Ramsay Hunt syndrome. [loyolamedicine.org]

Additionally, using artificial tears during the day and an eye lubricant at night can help to prevent drying out of the eye. [thailandmedical.news]

Prevention There is no known way to prevent Ramsay Hunt syndrome, but treating it with medicine soon after symptoms develop can improve recovery. [account.allinahealth.org]

There is no known way to prevent Ramsay Hunt syndrome, but treating it with medicine soon after symptoms develop can improve recovery. [nlm.nih.gov]

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3. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341-1349.
4. Sampathkumar P, Drage LA, Martin DP. Herpes Zoster (Shingles) and Postherpetic Neuralgia. Mayo Clin Proc. 2009;84(3):274-280.
5. Kim CH, Choi H, Shin JE. Characteristics of hearing loss in patients with herpes zoster oticus. Lin. Y-S, ed. Medicine (Baltimore). 2016;95(46):e5438.
6. Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash. Curr Top Microbiol Immunol. 2010;342:243-253.
7. Espy MJ, Teo R, Ross TK, et al. Diagnosis of Varicella-Zoster Virus Infections in the Clinical Laboratory by LightCycler PCR. J Clin Microbiol. 2000;38(9):3187-3189.