Herpes Zoster Auris Associated with Facial Nerve Palsy and Auditory Nerve Symptoms: A Case Report with Histopathological Findings

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Abstract
A typical case of herpes zoster auris is described. Sections of the temporal bone of the clinically affected side show extensive lymphocytic or round cell infiltration of the facial nerve throughout its length and of the auditory nerve. There is considerable perivascular “cuffing” by lymphocytes in the modiolus, in the perineural tissue of the facial nerve, the chorda tympani and the skin of the external auditory meatus. The vestibular, spiral and geniculate ganglia contain numerous normal-looking neurones, although there is scattered lymphocytic infiltration of the surrounding nerve tissue. There are no necrotic changes in the ganglia. This case is in complete accordance with the main histopathological findings in four cases previously described: there is profuse and widespread lymphocytic infiltration in the facial nerve. This is in striking contrast to the microscopical findings in Bell's palsy. The syndrome bearing Ramsay Hunt's name is based on a more extensive lesion of the facial nerve and other nerves and parts of the central nervous system than is implied by the somewhat misleading term “geniculate ganglionitis”. It is essential that patients suffering from herpes zoster auris—for which the term “cephalic zoster” is considered to be a more appropriate one—should be fully examined including lumbar puncture, and that in fatal cases, the brain and spinal cord should be obtained, if possible, for histopathological analysis.