From the Guidelines
Symptoms preceding shingles to the ear, also known as herpes zoster oticus or Ramsay Hunt syndrome, typically include pain, burning, tingling, or itching in or around the ear before the characteristic rash appears, and patients should seek medical attention promptly if they experience these symptoms, especially if they've had chickenpox in the past. These sensations may begin 1-5 days before the visible rash develops, as noted in the context of viral infections of the external ear, caused by varicella, measles, or herpes virus, which are rare but important on the differential of acute otitis externa 1. Patients might also experience ear pain, hearing changes, dizziness, or facial weakness on the affected side. Some individuals report headache, fever, or general malaise during this prodromal phase.
Key Symptoms
- Pain, burning, tingling, or itching in or around the ear
- Ear pain
- Hearing changes
- Dizziness
- Facial weakness on the affected side
- Headache
- Fever
- General malaise Early treatment with antiviral medications can reduce the severity and duration of the outbreak, and management involves prompt systemic antiviral therapy and systemic steroids, as indicated for herpes zoster oticus (Ramsay Hunt syndrome) 1. These symptoms occur because the varicella-zoster virus, which remains dormant in nerve tissue after a chickenpox infection, reactivates and travels along nerve pathways to the skin, causing inflammation and irritation before the visible rash appears.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Symptoms Preceding Shingles to the Ear
- Fever, pain, and itch are common symptoms before the onset of rash in herpes zoster, including ear shingles 2
- There is no specific information available on symptoms preceding shingles to the ear, but general symptoms of herpes zoster include fever, pain, and itch before the rash appears 2
- Herpes zoster oticus, or ear shingles, is a viral infection of the outer, middle, and/or inner ear due to varicella zoster virus (VZV) 3
Clinical Features of Herpes Zoster Oticus
- Herpes zoster oticus is associated with peripheral facial palsy, without other associated signs 3
- Ramsay-Hunt syndrome is a clinical diagnosis of herpes zoster oticus with facial palsy 3, 4
- Antiviral agents are the standard first-line treatment for herpes zoster infections, but their effectiveness in treating Ramsay Hunt syndrome is unclear 4
Treatment and Prevention of Herpes Zoster
- Oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, are used to treat herpes zoster and can reduce the duration and intensity of zoster-associated pain (ZAP) 5, 6
- Routine vaccination for individuals over 60 years has shown considerable effect in reducing the incidence of herpes zoster and post-herpetic neuralgia 2
- Treatment with antiviral drugs and analgesics within 72 hours of rash onset can reduce severity and complications associated with herpes zoster and post-herpetic neuralgia 2