Zoster oticus – causes, symptoms & treatment

Zoster oticus

Zoster oticus is a second disease with the varicella-zoster virus. The symptoms show up in the ear region.

What is Zoster oticus?

Zoster oticus is a special form of shingles (herpes zoster). This refers to an infectious disease in the course of which inactive herpes viruses become active again in the ganglia of the central nervous system (CNS). About 90 percent of the population falls ill with the varicella-zoster virus.

The initial infection occurs in the form of chickenpox (varicella). There is then immunity to chickenpox that lasts for the rest of life. However, around 20 percent of all patients can later develop shingles. People over the age of 40 are particularly affected. In some cases, shingles is accompanied by zoster oticus. There are no differences between men and women.


Zoster oticus is caused by the varicella-zoster virus. This is also called human herpes 3 virus. It belongs to the group of herpes viruses. The globally occurring pathogen is equipped with a double-stranded DNA including lipid envelope. The varicella-zoster virus primarily affects nerve cells.

The germ is able to survive in the nerve nodes of the spinal canal for a period of several years. Transmission to humans takes place by droplet infection. After the initial infection with chickenpox, the triggering viruses migrate along the nerve fibers into the spinal ganglia. There they can survive and are only reactivated after years or even decades.

Because reactivation leads to the destruction of larger spinal ganglion areas, this results in acute pain, also known as zoster pain. Possible reasons for reactivation of the virus are disorders of the immune system, a reduction in the strength of the immune system for reasons of age or immunosuppression, in which the immune system is specifically reduced during a transplant.

Likewise, diseases of the immune system such as AIDS (HIV) can lead to a disturbed immune system. Other conceivable triggers include toxic substances, serious infections such as rabies, UV rays or X-rays. In addition, transmission with the varicella-zoster virus to People who have not yet fallen ill with chickenpox.

Symptoms, complaints & signs

Zoster oticus is noticeable in the initial stage by fatigue as well as headache and body aches. A typical symptom of the disease is the appearance of blisters on the earlobes. They also appear in the external auditory canal and sometimes in the inner eardrum.

Sometimes they also occur on the tongue, on the soft palate and in the lateral area of the neck. The bubbles reach the size of a pinhead or a grain of rice. The water-clear stretched and bulging bubbles resemble pearls. They show a sharply defined reddening of the skin and appear within two to three days.

After a period of two to seven days, the contents of the vesicle take on a yellowish purulent tint, while the redness slowly subsides. After the blisters dry out after about a week, a yellowish or brownish crust develops. The disease lasts about two to three weeks and then regresses. Not infrequently, scarring in the form of light or dark skin spots comes to light.

The so-called zoster pain manifests itself during the disease within the ear, in the neck or in the lateral facial region. About two-thirds of all patients also suffer from on one side of the face. The corners of the mouth hang down, the eyelid cannot be completely closed and the frown is not possible.

Diagnosis & course of the disease

In order to diagnose zoster oticus, the doctor pays attention to the patient’s symptoms. Typical signs are redness and blisters on the ear. Only in problematic cases does further investigation be required. It is also possible to detect the triggering pathogen.

This process takes place via polymerase chain reaction from the contents of the vesicles or from affected tissue. Furthermore, it is possible to detect specific antibodies to the pathogen, but this is not considered to be particularly meaningful because the virus is already present in the body.

In most cases zoster oticus takes a positive course. Two-thirds of all patients heal without problems. Relapses are very rare. However, in people over the age of 60, the disease can last for a long time. The course of the disease is considered to be unfavorable if people with immune deficiency are affected by zoster oticus.


Zoster oticus can cause various complications in the course. Typical secondary symptoms include headaches and body aches. Most patients also develop blisters on their earlobes, which can become inflamed. If the bubbles spread to the inner eardrum, hearing problems and temporary deafness can occur. When the blisters appear on the tongue or gums, it causes problems with eating.

This can result in malnutrition with its typical complications and consequences. If the blisters are scratched, this can lead to the formation of scars. Accompanying these complaints occurs the so-called zoster pain.

This characteristic pain in the face and neck area increases as the disease progresses and is accompanied by visual field defects such as drooping corners of the mouth. Major complications are unlikely when treating zoster oticus. Problems can arise if the person affected is allergic to proven drugs such as valaciclovir or brivudine.

In addition, side effects and interactions can occur, for example in individual cases there are depressive moods or physical complaints such as headaches and body aches and gastrointestinal problems. Severe complications require hospital treatment.

When should you go to the doctor?

If the sufferer suffers from unexplained tiredness, a general feeling of illness or weakness, there is cause for concern. If these irregularities persist for several days or if they increase in intensity, a doctor should be consulted. In the event of body aches, a decrease in physical performance and diffuse exhaustion, it is advisable to consult a doctor. Changes in the appearance of the skin and in particular blistering on the face are signs of a disease.

Since zoster oticus is a viral disease, the pathogens can multiply unhindered in the body if left untreated and trigger an increase in symptoms. If blisters form in the ear or mouth, it is advisable to consult a doctor.

The treatment of zoster oticus is antiviral. It is important to start treatment no later than 72 hours after the onset of skin symptoms. Aciclovir is usually administered, which can be administered in the form of tablets or as an infusion. Other proven agents are valaciclovir , famciclovir and Brivudine , which also belong to the antivirals.

These active ingredients fight the growth and multiplication of herpes viruses by working against the structure of the virus DNA. After just a few hours, skin symptoms and pain are successfully suppressed. To treat the pain, the patient receives painkillers, anticonvulsants such as gabapentin or Antidepressants . Tricyclic antidepressants are particularly useful in the case of zoster neuralgia. In case of severe complications, hospital treatment is required.


Vaccination against chickenpox is considered the most sensible preventive measure against zoster oticus. If the chickenpox does not break out, zoster oticus cannot develop later. The chickenpox vaccination is one of the standard vaccination procedures for children and adolescents.


Follow-up care for zoster oticus includes what has already been said about self-help: A healthy lifestyle helps the patient to support the immune system so that it can counteract a new outbreak of the infection. This is important because the varicella-zoster virus has taken root in the body and is still latent in the body even after an outbreak has been fought successfully.

If the immune system weakens – be it due to other serious diseases such as cancer, increasing age, therapies that suppress the immune system or infections such as flu-like infections or gastrointestinal diseases, then the zoster viruses have it easy to break out again. Therefore, patients are advised to limit their alcohol consumption and to refrain from nicotine altogether.

A balanced, fresh diet is indispensable for the immune system, as is physical exercise in the fresh air, which trains the heart and circulation. In the case of nutrient deficiencies, the administration of appropriate dietary supplements helps. Patients should consult their GP on this. In Germany, vaccines against shingles have been available for some time. These also protect against a zoster oticus outbreak, since both shingles and zoster oticus are triggered by the same herpes viruses. Most health insurance companies reimburse this vaccination, especially if the patient is over fifty years old.

You can do that yourself

In most cases, major complications only occur with zoster oticus if the immune system is very weak. It is therefore particularly important for the affected patients to ensure a stable immune system. This is especially true for people over the age of sixty.

The immune system is positively stimulated by patients avoiding stimulants such as alcohol and nicotine, but eating a balanced diet, paying attention to extended rest periods and moving as much as possible in the fresh air. It is still advisable to drink one and a half to two liters of still water daily, as it supports the excretory organs in their work and helps to remove pollutants.

During the acute phase of zoster oticus, the painful blisters of zoster oticus can make it difficult for patients to eat. However, especially in immunocompromised patients, this can quickly lead to malnutrition. For them, it is particularly important to pay attention to a fresh, balanced During the acute phase of zoster . If it is impossible for these patients to eat three to five times a day, they should inform their doctor. He may try to compensate for any deficiencies with dietary supplements or artificial feeding.

During the phase of the disease, the patient may experience depressive moods. In this case, the doctor will prescribe an antidepressant. Psychotherapeutic crisis intervention is also conceivable.

Website | + posts

Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.