Clin Exp Otorhinolaryngol.  2008 Mar;1(1):15-19. 10.3342/ceo.2008.1.1.15.

Statistical Analysis of Pure Tone Audiometry and Caloric Test in Herpes Zoster Oticus

• Kim J
• Jung J
• Moon IS
• Lee HK
• Lee WS

• KMID: 1486030
• DOI: http://doi.org/10.3342/ceo.2008.1.1.15

Abstract

OBJECTIVES
Pure tone audiometry and caloric test in patients with herpes zoster oticus were performed to determine the biologic features of the varicella zoster virus (VZV) and the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus. Study Design: A retrospective chart review of 160 patients with herpes zoster oticus was designed in order to determine the classic characteristics of vestibulocochlear nerve disease associated with the syndrome. Speech frequency and isolated high frequency acoustic thresholds were analyzed based on severity of facial paralysis and patient age. Patients without cochlear symptoms were selected randomly, and audiological function was evaluated. Patients with symptoms of vestibular dysfunction underwent the caloric test, and canal paresis was analyzed according to the severity of facial paralysis and the age of each patient. RESULTS: Among the 160 patients, 111 exhibited pure tone audiometry; 26 (79%) of the patients with cochlear symptoms and 44 (56%) of the patients without cochlear symptoms had abnormal audiological data. Among the patients without cochlear symptoms, 15 (19%) had hearing loss at speech frequency, and 42 (54%) had hearing loss isolated to high frequency. The incidence of cochlear symptoms in herpes zoster oticus was not related to the severity of facial paralysis. The incidence of patients with isolated high frequency hearing loss statistically increased with age, however the incidence of patients with speech frequency hearing loss did not increase. Thirteen patients complained vertigo, and the incidence of vestibular disturbances and the value of canal paresis in the caloric test increased to statistical significance in parallel with increasing severity of facial paralysis. CONCLUSION: Mild or moderate cochlear symptoms with high frequency hearing loss were related to age, and severe vestibular symptoms were related to the severity of facial paralysis after onset of herpetic symptoms. This study might suggest us a clue to the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus.

Keyword

Herpes zoster oticus; Vestibulocochlear nerve disease; Facial paralysis

MeSH Terms

Acoustics
Audiometry
Caloric Tests
Facial Paralysis
Hearing Loss
Herpes Zoster
Herpes Zoster Oticus
Herpesvirus 3, Human
Humans
Incidence
Paresis
Retrospective Studies
Vertigo
Vestibulocochlear Nerve Diseases

Figure

• 

  Fig. 1 The mean acoustic threshold and standard errors of affected ears and unaffected ears of 111 patients with herpes zoster oticus. The mean acoustic threshold at all frequencies showed a statistical difference between the affected ear and the normal ear. The difference of mean acoustic threshold between the affected ear and the unaffected ear increased as examination frequency was made higher.

• 

  Fig. 2 The comparison of the mean hearing loss level in affected ear at 0.25, 0.5, 1, 2, 4, and 8 kHz between patients with cochlear symptoms and patients without cochlear symptoms. Statistically significant difference was demonstrated between the two groups at all frequencies examined. However, the mean hearing loss values in patients without cochlear symptoms at 4 kHz and 8 kHz was found to be higher than 10 dB.

Reference

1. Hunt JR. On herpetic inflammations of the geniculate ganglion. A new syndrome and its complications. J Nerv Ment Dis. 1907; 2. 34:73–96.

2. Wackym PA. Molecular temporal bone pathology: II. Ramsay Hunt syndrome (herpes zoster oticus). Laryngoscope. 1997; 9. 107(9):1165–1175. PMID: 9292598.

3. Hunt JR. The symptom complex of the acute posterior-poliomyelitis of the geniculate, auditory, glossopharyngeal and pneumo-gastric ganglia. Arch Int Med. 1910; 5:631–675.

4. Kaberos A, Balatsouras DG, Korres SG, Kandiloros D, Economou C. Audiological assessment in Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol. 2002; 1. 111(1):68–76. PMID: 11800372.

5. Lu YC, Young YH. Vertigo from herpes zoster oticus: superior or inferior vestibular nerve origin? Laryngoscope. 2003; 2. 113(2):307–311. PMID: 12567087.

6. Blackley B, Friedmann I, Wright I. Herpes zoster auris associated with facial nerve palsy and auditory nerve symptoms: a case report with histopathological findings. Acta Otolaryngol. 1967; 6. 63(6):533–550. PMID: 6037903.

7. Kuhweide R, Van de Steene V, Vlaminck S, Casselman JW. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol. 2002; 10. 116(10):844–848. PMID: 12437843.

8. Murakami S, Nakashiro Y, Mizobuchi M, Hato N, Honda N, Gyo K. Varicella-zoster virus distribution in Ramsay Hunt syndrome revealed by polymerase chain reaction. Acta Otolaryngol. 1998; 3. 118(2):145–149. PMID: 9583779.

9. Byl FM, Adour KK. Auditory symptoms associated with herpes zoster or idiopathic facial paralysis. Laryngoscope. 1977; 3. 87(3):372–379. PMID: 557156.

10. Wayman DM, Pham HN, Byl FM, Adour KK. Audiological manifestations of Ramsay Hunt syndrome. J Laryngol Otol. 1990; 2. 104(2):104–108. PMID: 2324614.

11. Abramovich S, Prasher DK. Electrocochleography and brain-stem potentials in Ramsay Hunt syndrome. Arch Otolaryngol Head Neck Surg. 1986; 9. 112(9):925–928. PMID: 3741657.

12. Oxman MN. Immunization to reduce the frequency and severity of herpes zoster and its complications. Neurology. 1995; 12. 45(12 Suppl 8):S41–S46. PMID: 8545018.

13. Miller AE. Selective decline in cellular immune response to varicella-zoster in the elderly. Neurology. 1980; 6. 30(6):582–587. PMID: 6247671.

14. Ozdogmus O, Sezen O, Kubilay U, Saka E, Duman U, San T, et al. Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal. J Anat. 2004; 7. 205(1):65–75. PMID: 15255963.