A patient develops severe otalgia, vesicles in the concha, complete ipsilateral facial weakness and vertigo. What treatment principle is most appropriate?
Herpes zoster oticus with facial palsy is Ramsay Hunt syndrome. Early combined treatment is generally used, while corneal protection, hearing and vestibular assessment address important morbidity.
A. Treat as uncomplicated Bell palsy without examining the ear: Vesicles and vestibulocochlear symptoms identify zoster involvement.
B. Delay treatment until vesicles crust: Treatment benefit is time-sensitive.
C. Perform immediate parotidectomy: The palsy is viral neuritis, not a parotid lesion.
D. Prompt antiviral and corticosteroid treatment with meticulous eye protection: Herpes zoster oticus with facial palsy is Ramsay Hunt syndrome. Early combined treatment is generally used, while corneal protection, hearing and vestibular assessment address important morbidity.
E. Patch the eye without lubrication or closure assessment: Exposure protection requires active surface care and escalation if closure is inadequate.
If vesicles were absent initially, zoster sine herpete would remain possible, but alternative central and neoplastic causes must also be considered.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
Back to the Section 1 bank