Historical features:
(1) childhood history of chickenpox, although this may be lacking
(2) concurrent stress or diseases causing reduced immunity
Clinical features are usually unilateral:
(1) deep burning pain in the affected ear
(2) vesicles in the external auditory canal
(3) facial paralysis on the affected side
(4) transient spontaneous nystagmus
(5) sensorineural hearing loss
(6) vertigo
Laboratory findings:
(1) positive culture for Herpes zoster
(2) increase in serum antibodies
Neurologic testing:
(1) abnormal brain stem auditory evoked response
(2) vestibular paresis on bithermal caloric test
where:
• PCR on the vesicle fluid should be useful.
