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Herpes Zoster Otikus

09 Jan

Herpes Zoster Otikus adalah infeksi virus pada telinga dalam, telinga tengah dan telinga luar. HZO manifestasinya berupa otalgia berat yang disertai dengan erupsi kulit biasanya pada CAE dan pinna. Bila disertai dengan paralisis n VII maka disebut sebagai Ramsay Hunt Syndrome. Patofisiologi : merupakan reaktifasi dari varicella-zoster virus (VZV) yang terdistribus sepanjang saraf sensoris yang menginervasi telinga, termasuk didalamnya ganglion genikulatum. Apabila gejala disertai kurang pendengaran dan vertigo, maka ini adalah akibat penjalaran infeksi virus langsung pada N. VIII pada posisi sudut serebelo pontin, atau melalui vasa vasorum. Anamnesis disertai riwayat : nyeri dan terasa panas pada sekitar telinga, wajah, mulut dan lidah. Vertigo, nausea, muntah. Kurang pendengaran, hiperakusis, tinitus. Rasa sakit pada mata, lakrimasi. Vesikel bisa muncul sebelum, selama maupun sesudah terjadinya paralisis n VII.

Perlu ditanyakan riwayat pernah terkena cacar air sebelumnya, bahkan saat masih kecil. Terapi : sampai saat ini sifatnya hanya suportif misalnya kompres hangat analgetik narkotika dan antibiotika untuk mencegah sekunder infeksi. Sebenarnya antivirus memberikan efek yang baik yaitu penyakit menjadi tidak terlalu berat dan cepat membaik.

A 28-year-old Asian man presented to the Ben Taub General Hospital with right facial hemiparesis, a varicelliform rash in his right conchal bowl and lateral external auditory canal, and severe right otalgia. He described a gradual onset of right otalgia followed by right conchal bowl erythema and edema three days before presentation. He began having dry mouth and decreased taste over the right side of his tongue just prior to the development of the rash. The rash and facial nerve palsy were noted simultaneously. He had no complaints of dizziness, vertigo, or tinnitus but did have decreased hearing in the right ear. There was no past history of varicella infection. Physical examination revealed a thin Asian man with stable vital signs and no fever. A rash composed of vesicles of different ages filled the conchal bowl and lateral external auditory canal. The tympanic membrane had no lesions and the chorda tympani nerve could not be seen. Minimal forehead movement and near complete eye closure were noted with no other facial motor function on the right side. Otologic examination was normal on the left. The remainder of the neurological examination was without abnormality. Schirmer testing revealed bilaterally symmetrical tearing to 2 centimeters.

Audiometric analysis showed mild sensorineural hearing loss to 2000 Hz on the right side with moderate sensorineural loss above 4000 Hz bilaterally. No crossed stapedial reflex could be elicited on the left. The tympanogram was type A on the left and type B on the right.

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Ditulis oleh pada Januari 9, 2008 in telinga

 

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