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Herpes Zoster Oticus (HZ oticus) is a form of shingles that is restricted to the area of the ear and its surroundings.
Figure 1: Herpes zoster oticus typically results in an itchy rash that is characterized by fluid filled bumps (vesicles)1. After an initial chicken pox infection, typically during childhood, the virus will remain dormant within the nerve centers of the body.
Herpes Zoster Oticus can potentially affect anyone that has had a previous chicken pox (varicella-zoster) infection.
If not treated in a timely manner, HZ oticus can lead to potential nerve damage and subsequent dysfunction.
Figure 2: The facial nerve can be affected by inflammation due to a herpes zoster oticus infection. HZ Oticus is typically treated with antiviral medications and corticosteroids to suppress viral activity and decrease inflammation. All cases of suspected Herpes Zoster Oticus should be promptly evaluated and treated by a qualified otolaryngologist. If you would like to speak with one of our physicians regarding this issue or another ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.
Ophthalmic nerve travels through the ceiling of the orbit and enters the face above the eye. Mandibular nerve: mental branch travels along the inner side of the jawbone, enters the skin on the sides of the chin and innervates the skin of the jaw. Sensitivity of the BACK OF THE HEAD is mediated by the first three spinal nerves (cervical nerves C1-C3) . Sensitivity of the NECK and most of the EARLAP is provided by the superficial cervical plexus composed by cervical nerves C1-C4. Causes include: spinal disorders, like herniated disc, neurological diseases, like multiple sclerosis, vascular disorders, like atherosclerosis, infections, like meningitis, poisoning, epilepsy, tumors, injuries, metabolic changes, like hypokalemia, and other causes listed below. Tingling on the one side of the face, scalp or trunk, followed by a band of red patches and painful blisters that crust over and fall off in 2-3 weeks. Post herpetic neuralgia is a complication of Herpes zoster reactivation, mostly seen in patients over 50 years of age.
Circular red rash with a pale centre appearing few days or weeks after a tick bite (rash lasts few weeks).
Months or years after the tick bite (there is no rash at that time), tingling, paralysis of facial muscles, vision disturbance, problems with memory, migratory joint pain (especially in knees) and heart problems can appear. Sudden severe shock-like (or mild) facial pain, lasting from few seconds to two minutes, triggered by tooth brushing, shaving, chewing, speaking, laughing, or even a slight breeze. Trigeminal neuropathic pain can appear as a complication of trauma, dental procedure, surgery, or disease, like diabetes or stroke. Pain in trigeminal deafferentation (interruption of sensory nerve fibers) results from nerve damage, usually during treatment of trigeminal neuralgia (alcohol injections, surgery). Multiple sclerosis (MS) is, as believed, an autoimmune disease affecting the brain, brainstem or spinal cord. Transverse myelitis and acute flares of multiple sclerosis are often treated with steroids.
Ciguatera poisoning after eating big tropical fish, scombroid poisoning with spoiled fish, and paralytic shellfish poisoning can causetingling, skin rash and diarrhea.
Stroke is a damage of a part of the brain, occurring after a blockage or break of the brain artery due to atherosclerosis, thrombosis or rupture of an arterial aneurysm. In vertebrobasilar circulatory disorders, blood supply to the back of the brain, little brain (cerebellum), and brainstem is disrupted due to blocked basilar or vertebral arteries.
Sharp or dull pain behind the breast-bone, triggered by effort, strong emotions, cold, heavy meal, or other stress; lasting from few moments to 10 minutes (up to 30 minutes in severe cases). Spinal cord injuries of the upper cervical (neck) spine (above the C4 level) may result in back of the head numbness. A tumor or abscess (collection of pus after infection) in the brain, orbit, ear, nose, paranasal sinuses, mouth, parotid glands, muscles or skin, skull, vertebra or spinal cord can directly press on the nerve tissue or infiltrate it, thus causing unusual sensations or pain in the face or back of the head.
Substances, like serotonin, secreted by various tumors (especially lung cancer and carcinoid) can cause paresthesia in any body part.
Alcohol causes alcohol neuropathy (chronic paresthesia), but it can be directly toxic to nerves (acute paresthesia). Other head related symptoms: pain, vision, hearing, smell, taste, temperature sense, or balance problems.
Ask a Doctor Online Now!Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. Its richa again, i am sorry i forgot to mention i regularly do yoga since i got bell palsy (right side of face). Richa Tiwari, I’m not sure if herniated disc in the neck can be excluded as a cause of pain. Richa Tiwari, large tonsils may be normal, but they could be caused by chronic tonsillitis – an ENT can make a diagnosis.
The problem occurs mostly when I have a cold, but that might obviously be because I blow my nose a lot more often at that time. From the description of the nerves in the article, it definitely seems to be the maxillary nerve that is in cause.
Nick, an anatomical disorder, like a deviated septum, or a polyp or inflammation in the nose or maxillary sinus could result in increased pressure in the nose and sinus and cause symptoms you’ve described. I wonder if you can advise me, I woke up one morning in January with numbness and pain on the right hand side of my face from my temple to my cheek, this was followed closely by pain on that side which was very uncomfortable.I woke up with large nayl discharge that first morning, like large tubes of mucus. David, as you probably know, symptoms in the ring fingers could arise from pinched spinal nerves due to bulging cervical discs. I have constant facial tingling (just above left and right eye brows and forehead, and upper lip). In 2004 I had two incidents happen, The first was a bike accident which severely jarred my neck. David, you may check this personal medical history questionnaire and write down your complete medical history with all your current symptoms, past symptoms, investigations and their results.
Atherosclerosis is a common complication of long term diabetes, especially when a diabetic has not been adequately managing their glucose levels.
I don’t think you should put so much credence into the aspartame lowering your blood pressure just yet.
Don’t get too distracted with self-diagnosing as you can sometimes do more harm than good. Anyway, since then, I’ve had my medication dosage sorted, but the entire left side of my body has been tingly and numb. My psychiatrist is not interested in taking me off of Effexor, saying she’s never heard of this reaction to the medication. My symptoms have returned and I saw a new neurologist and he ordered another MRI and bloodwork. So, after having another MRI with normal results and further bloodwork done, I tested positive for Sjogrens Syndrome, an autoimmune disorder. Is this something that would be best managed through a rheumatologist, my neurologist or my primary? If you've ever had the chickenpox -- and almost all adults have -- there's a good chance the virus is still at large in your body. The shingles rash can be a distinctive cluster of fluid-filled blisters -- often in a band around one side of the waist.
Small blisters that appear only on the lips or around the mouth may be cold sores, sometimes called fever blisters.


Shingles blisters usually scab over in 7-10 days and disappear completely in two to four  weeks.
In some older people, the pain of shingles may linger for months or even years after the rash has healed.
If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. While there is no cure for shingles, antiviral medications can put the brakes on an attack.
Over-the-counter pain relievers and anti-itch lotions, such as calamine, can relieve the pain and itching of the shingles rash. Colloidal or powerderized oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles as well. Shingles and Herpes Zoster Oticus are a reactivation of the Varicella-Zoster Virus, also known as the chicken pox virus. In normal situations, the body’s immune system keeps the virus at bay and the patient symptom free. Because the immune system is able to suppress shingles infections (including HZ oticus) those with weakened immune systems are more likely to develop HZ oticus. As the diseases progresses, inflammation of underlying nerves can result in moderate to severe pain as well as changes in hearing, facial muscle control, and taste disturbances.
Because of their close anatomical relationship, the nerves of hearing, facial sensation, and taste can all become simultaneously affected during an HZ oticus infection.
Prompt evaluation and treatment is recommended to avoid or decrease the complications associated with nerve damage such as severe pain, hearing loss, and facial distortion.
These specialists have experience in recognizing this condition and initiating appropriate treatment to decrease the likelihood of complications and permanent injury.
It is designed to provide reliable medical information in a format that is easy to understand. It innervates the front half of the top of the head, forehead, eyebrow, upper lid, the skin on the top of the nose, cornea, eye conjunctiva, and frontal sinuses.
It innervates the skin on cheeks, upper lip, sides of the nose, lower eyelid, a part of mucosa in the nose, paranasal sinuses, upper gum, and upper teeth.
Auriculotemporal branch innervates the skin in the front of the earlap, and temporal region. Dislocated jaw may cause pain or numbness in temporal and jaw area – temporomandibular (TMP) pain. Actually, it seems to happen most often when I just got out of bed and blow my nose for the first time of the day.
I can’t give you an exact answer, but tingling and pain can arise from a teeth or inflammation around certain teeth pressing upon the nerve (mandibular or maxillary branch of the Trigeminal nerve), from sinusitis (?), nasal polyps, or anatomical abnormality in the mouth (possibly related to impacted tooth). I had a minor bladder surgery ten days ago under anesthesia with darvocet and a steroid to combat nausea and wa sent home with cipro. If symptoms are not worsening, you can wait a bit to see if they will go away on their own; if not you can ask the doctor. Forgive my first email with so many words spelled incorrectly as I could only see half the screen.
If it doesn’t seem to get better, you might want to visit an ENT, who can judge if some inflammation has occurred, which needs to be treated. Initially it started as chest pain (ECG clear)Chronic fatigue (Diabetes clear and B12) Night Sweats,Burning in ring fingers of both hands,mono-neuropathy in both feet worse if I eat sugar or carbs.Tingling in side of face, top of head,tip of nose, symptoms come and go and change all the time. The second was I got a red painless rash on my left arm which could be attributed to Lyme, I live in an active lyme area, in the UK. In all likelihood this is more likely to be associated with the restricted blood flow to the brain due to the fact that it is one sided and extending all the way to the legs. It is further complicated by the fact that you also have hypertension, another cause of atherosclerosis. Rather speak to another doctor in person for confirmation that your current doctor’s approach is valid.
Numbness is not as prominent and long lasting with a heart attack (MI) as it is for cervical spondylitis.
I won’t get into specifics about how it all happened, but it was an accident out of desperation to get back on my medication after not having it for a year, without tapering back onto it. The back of my head, left side of my face, my whole mouth inside and out, my left arm and leg and parts of the left side of my torso are all tingly and less sensitive to the touch than the right side.
MS would be a reasonable consideration given your history but this has been ruled out by the neurologist. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. If you have shingles symptoms, see your health care provider even if you think you've never had chickenpox. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. So keep a shingles rash covered and avoid contact with infants, as well as pregnant women who have never had chickenpox or the varicella vaccine. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Prompt treatment can make a case of shingles shorter and milder, while cutting in half the risk of developing postherpetic neuralgia. If the pain is severe or the rash is concentrated near an eye or ear, consult your doctor right away. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams.) If your doctor gives you the green light, stay active while recovering from shingles. In a large trial, this vaccine cut the risk of developing shingles in half and reduced the risk of postherpetic neuralgia by 67%. Raphael Nach is board certified in plastic surgery and otolaryngology and has been in practice for over 30 years.
Occasionally, when the immune system has been weakened, the virus will emerge and cause a painful chicken pox like rash. The immune system can typically be weakened by situations including: chemotherapy, radiation therapy, cancer, autoimmune disorders, stress, and chronic illness.
Inflammation caused by the virus leads to compressive damage of the delicate nerves of the face and ear.
In some cases pain medication is also prescribed to address pain due to neurological injury. As Chief of Medical Resources, I hold an undergraduate degree in Neuroscience from the University of California, Los Angeles and a graduate degree in Medical Science from the University of Southern California. Like said, a neurologist can say, if any other neurological investigation would reveal, if you have pinched nerves in the neck or not. I went to the doctor 7 days ago because I thought I just had a bad ear infection but he said something about bells palsy and put me on both and antibiotic and a steroid. There is a constant pain behind both eyes that gets worse in sunight and artificial lighting.
Relatively often, I hear that pressure-releasing sound from my nose right after blowing it, and then I don’t get any numbness. This has been happening irregularly for about two years, and I had never had anything similar occur before that. So I would guess that somehow blowing my nose sometimes creates a pressure on this nerve resulting in my symptoms. The lipoma issue may also be relevant but right now the focus should be on preventing a blood clot from forming which can be done with aspirin.


Ideally you should see a neurologist at this point so that further assessments can be done but if your doctor does not feel it necessary then don’t rush the issue just yet. In an MI there is pain that comes on suddenly although the head, face and upper back are not commonly affected. When I first wake up, it’s really intense, like the sensation of old fashioned TV static, but it never fully goes away. Because of this, my primary care doctor has referred me to neurology and I’ll be going in next week. The other investigations that you had would show if blood flow is compromised to the brain which would cause some of the symptoms you are experiencing. Sjogren’s is one of the most common rheumatological conditions although it is widely heard of. Itchy blisters that appear after hiking, gardening, or spending time outdoors could be a reaction to poison ivy, oak, or sumac. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner. The vaccine won't treat a current outbreak of shingles, but it can prevent future attacks if you have already had shingles. In addition, because the efficacy of the immune system decreases with age, HZ Oticus is disproportionally seen in older age groups vs. I finished both medications and the tingling is mostly gone but am having some numbness on the right side of my face to my chin and above my ear and my ears feel plugged. You can wait for some days to see if symptoms are lessening – in this case they will probably go away completely in a due time.
I had a very long day at work and became tired and felt the tingling crepping feeling come back again.
I also got badly scratched on my arm by a neighbours cat, (bartonella?) although I do not rememeber specifically getting bitten by a deer tick.
As said in the previous reply, don’t put too much of weight into claims that aspartame lowers you blood pressure or has other health benefits.
I have a friend who was diagnosed with guillan barre syndrome and she has some similar symptoms. Long term management may then be handed over to your primary with occasional follow ups with the rheumatologist. Instead, it settles in nerve cells and may reactivate years later, causing shingles.  It's also called herpes zoster, but it's not related to the virus that causes genital herpes.
In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression. These complications can usually be prevented by beginning treatment for shingles as soon as possible. Nach became an American citizen in 1978 and has been in practice across the country since then. I saw three dentists in total and had my top wisdom tooth removed, along with three root canals on the top right hand side. Drugs may have their side effects (which could be your symptoms), so in attempt to find a cause you can ask the doctor which drugs are still necessary and which not. I took tylenol sinus and did a nasal sinus wash , but squeezed way to hard and then sucked it up only ot feel like my nose was hit with a fire hose stream with saline. When you are looking at numbness in these areas (head, face, upper back) due to a cardiovascular cause then you may instead be looking at something like a stroke rather than a heart attack. Then, last year (2014) I was working out with a personal trainer on the weight bench and pushed up with the bar and it was very painful in my right arm near armpit area.
Given your age it is advisable that you consult with a cardiologist just to ensure that there is no underlying cardiovascular condition. Symptoms from brain tumor, stroke or multiple sclerosis, for example, would not likely lessen after the medications you’ve got. I have been tested for tick borne illnesses because I am around them for school and they often get attached. The wisdom tooth extraction on the last visit rid me of the pain, but since then I have had to a less or greater extent the pins and needles sometimes across both cheeks, and across my nose.
Symptoms never constant, I’m really really curious and frustrated at what is going on with my health, 46 year old man, slight BMI issue through lack of exercise due to conditions, never smoked and no cannot tolerate alcohol. How did the symptoms start in 2004 – suddenly or slowly, and can you recall any circumstances?
The feet specifically burn after excess sugar or carbs and I tend to have enforced sleep too. During the night & waking up seems to be the worst, as well as days i dont get much sleep, however it came be at any time, for no reason. The very next day I began with numbness on my right side (arm, face, leg) It lasted for a week or so. This is not to say that aspartame is bad but too much of even a good thing can have deleterious effects.
Both an MI and stroke are acute in nature (most of the time) so the symptoms will develop over a short period of time. It is also advisable to follow up with an opthamologist (eye specialist) to exclude certain eye conditions. I had had ear fullness for months upto that point and had been very feverish under any movement.
Dizziness and breathlessness are some of the symptoms you would also be looking at, and sudden profuse perspiration with an MI. It really is difficult to say what this could be given that you have undergone so many tests and everything is clear thus far. The removal of the tooth seemed to make the ear fullness disapear pretty much after the removal.
Thank you for your reply, your help is much appreciated Regards David Were other vitamins, except vit B12, and mineral levels also tested? As you have mentioned there is no infection but this does not exclude the possibility of a neuralgia among the other conditions. Another consideration would be anemia and perimenopause although your doctors would have considered this. My doctor has pescribed me amytriptyline 20mg which I have been taking the last ten months, but am not sure if they are making any difference as in the last week the symptoms are back as bad as nearly at the begining, tingling creeping burning(withou the pain). How did the symptoms start in 2004 – suddenly or slowly, and can you recall any circumstances? When I finally DO fall asleep, when I wake up I’m still so exhausted that I can barely get out of bed.
However, your neurologist has both the knowledge and first hand experience with your case to assist you further.
Well, every several months I have this numbness on my right side and it’s coupled with a dizzy, foggy, almost drunk feeling and right eye pressure.
Stress can definitely cause many of the symptoms you are experiencing but it is always advisable for first exclude some of the conditions mentioned above.



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