ear, nose, and throat disorders
Herpes Zoster Oticus
Treatment of Herpes Zoster Oticus
Antivirals and corticosteroids Sometimes for complete facial paralysis, surgical decompression of the fallopian canal Although there is no reliable evidence that corticosteroids, antivirals, or surgical decompression make a difference in herpes zoster oticus, they are the only possibly useful treatments. When used, corticosteroids are started withprednisone60 mg orally once a day for 4 to 7 days, followed by gradual tapering of the dose over the next 2 weeks. Eitheracyclovir800 mg orally 5 times a day orvalacyclovir1 g orally 2 times a day for 10 days may shorten the clinical course and is routinely prescribed for immunocompromised patients. Vertigo is effectively suppressed withdiazepam2 to 5 mg orally every 4 to 6 hours. Pain may require oral opioids. Postherpetic neuralgia may be treated with medications (eg,amitriptyline,nortriptyline,gabapentin,pregabalin). The role of surgical treatment of facial paralysis remains controversial; however, surgical decompression of the fallopian canal may be considered if the facial palsy is complete (no visible facial movement). Decompression must be done within 2 weeks of onset of the facial paralysis to be effective. Before surgery, electroneurography is done. Patients with a>90% decrement in facial movement are usually candidates for decompression. 