Dr. Tran Xuan Nguyen, an ear, nose, and throat specialist at Tam Anh District 7 General Clinic, performed an ear endoscopy. He found Loan's auricle swollen and congested, diagnosing auricular dermatitis, suspected to be shingles. She received medication for symptoms and antibiotics to prevent secondary skin infection, with a follow-up scheduled in two days.

During the follow-up visit, Dr. Nguyen observed initial signs of mild unilateral facial weakness and incomplete eye closure. This indicated a swollen and compressed facial nerve. He diagnosed Loan with ear shingles and monitored her for Ramsay Hunt syndrome, a condition affecting about 5 in 100,000 people.

Shingles is an infection caused by the varicella-zoster virus. This virus initially causes chickenpox upon entering the body. While the immune system typically eliminates most of the virus, some remain dormant in the nerves. If the immune system weakens, the virus reactivates, leading to the characteristic shingles rash.

According to Dr. Nguyen, if the virus reactivates in the geniculate ganglion of the seventh (facial) and eighth (auditory) cranial nerves, it causes an ear rash, known as ear shingles. When ear shingles results in facial paralysis and tinnitus, as in Loan's case, it is termed Ramsay Hunt syndrome.

Loan at her one-month follow-up, with no more facial paralysis. *Photo: Tam Anh District 7 General Clinic*

After one week of medication, Loan's headaches, tinnitus, and dizziness subsided. She continued her treatment and physical therapy, aiming for her face to return to normal. Her facial paralysis resolved after one month.

Dr. Nguyen advised Loan to receive the shingles vaccine post-recovery. While treatment addresses the active virus, recurrence is possible as the virus can remain dormant, reactivating when the immune system weakens. Other risk factors for shingles include being female, aged 65 or older, a history of physical trauma, or chronic conditions such as lung or kidney disease.

In its initial stage, ear shingles presents with non-specific symptoms like headaches, dizziness, and tinnitus, which are easily mistaken for inner ear conditions or vestibular disorders. Early skin lesions often appear as small red spots, similar to common dermatitis, without the characteristic blisters. This can lead to misdiagnosis and missing the critical "golden" treatment window, within 72 hours of symptom onset.

Dr. Nguyen advises individuals with headaches, dizziness, tinnitus, or skin lesions around the ear to seek medical attention. Ear shingles generally responds well to timely treatment. However, delayed intervention can lead to long-term complications, including prolonged postherpetic neuralgia, unilateral peripheral facial paralysis, and irreversible deafness.

By Uyen Trinh

*Patient's name has been changed