Clinical presentation
RHS is a diverse and challenging disease, since it can be
associated with neurological symptoms mimicking other
diseases. Pathognomonic for the syndrome are peripheral facial
nerve palsy and vesicular rash on the external ear, external
auditory canal (which might only be visible by otoscopic
assessment), and/or the mucosa of the ipsilateral part of the
tongue or palate, usually accompanied by otalgia (Figures 2a
and 2b) [1,7]. By contrast there are also reports on facial nerve
palsy and other cranial nerve palsies without herpetic lesions
but with an increase of VZV antibodies, so called zoster sine
herpete [51-53]. Pain in the affected area develops prior to a
vesicular rash in 14-50% of VZV patients; the pain may mimic