Herpes Zoster Oticus
The patient should be started immediately on a course of oral acyclovir.
Topical acyclovir ointment should also be applied to the cutaneous lesions. The vesicles should be kept dry and an oral antipruritic such as an antihistamine administered to prevent scratching and subsequent secondary infection.
In those cases in which a total facial nerve paralysis has occurred, the use of oral prednisone in high doses is sometimes beneficial.
Steroids may also be used to prevent subsequent post herpetic neuralgia.
Complete recovery of facial nerve function is less common than with Bell's palsy.
Some surgeons advocate surgical decompression of the facial nerve up to and including the internal auditory canal.
Numerous crusted vesicles are seen scattered throughout the conchal bowl