Herpes Zoster Oticus: Systematic Review of Clinical Prognostic Factors

Cassettari, Arthur Justi; Silva, Vagner Antônio Rodrigues; Crespo, Agrício Nubiato

doi:10.1055/s-0045-1810000

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Systematic Review • Int Arch Otorhinolaryngol. 30 (1) • 2026 • https://doi.org/10.1055/s-0045-1810000 linkcopy

Herpes Zoster Oticus: Systematic Review of Clinical Prognostic Factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction Herpes Zoster Oticus is etiologically associated with the reactivation of the Varicella-Zoster virus in the geniculate ganglion. Its primary manifestation includes pain, vesicles in the external auditory canal, and peripheral facial paralysis. The prognosis of the syndrome remains under scrutiny and debate, fluctuating based on symptom severity and clinical manifestation. The scarcity of articles accurately correlating clinical presentation and prognosis, coupled with individual factors and the syndrome's rarity, constrains more comprehensive analyses.

Objectives To conduct a systematic review to determine whether it is possible to predict the prognosis of RHS based on clinical factors.

Data synthesis This study identified a total of 6,464 articles within the databases, which were subsequently evaluated by two independent researchers. Sixty-two articles underwent full-text examinations, and following meticulous selection criteria, twelve articles were ultimately incorporated into this study. Factors such as age, onset of House-Brackmann degree, dizziness, hearing loss, time to treatment initiation, and comorbidities appear to exert influence on prognosis. The articles exhibit methodological limitations and discrepancies among them, stemming from variations in prognostic concepts, treatment protocols, evaluation timing, or reported outcomes. These variations hinder the possibility of conducting a methodologically sound comparison, regardless of how closely aligned the trials are with the theme.

Conclusion The review concludes that it is not possible to definitively assert the presence of a clinical parameter defining the prognosis in Herpes Zoster Oticus.

Keywords
facial paralysis; Herpes Zoster Oticus; prognosis

Author (year)	VZV patients	Follow-up	Clinical Prognostic Factors (p < 0.05)
Ko et al. (2000) ²¹	n = 45	58.7 days (average)	Age, polyneuropathy, onset degree *
Uri et al. (2003) ²²	n = 31	12 months	Dizziness, hearing loss, treatment onset timing***
Yeo et al. (2006) ²³	n = 26	6 months	Age, onset degree, SAH, DM, dizziness
Kim et al. (2010) ¹³	n = 11	11.3 months (average)	None
Coulson et al. (2011) ²⁴	n = 101	12 months	Onset degree, incomplete eye closure, dry eye, steroid treatment after 5 days
Ryu et al. (2012) ²⁵	n = 155	3 months	Onset degree, DM, SAH, age, treatment onset timing
Byun et al. (2013) ²⁶	n = 22	12 months	Dizziness, hearing loss
Shin et al. (2015) ²⁷	n = 81	Not included	Dizziness
Cai et al. (2017) ²⁸	n = 23	6 months	Age, SAH, DM
Kim et al. (2019) ²⁹	n = 106	6 months	Onset degree V or VI without comorbidities
Kanerva et al. (2020) ¹⁴	n = 120	6.6 years (median)	Onset degree*, treatment onset timing*
Rim et al (2023) ³⁰	n = 192	12 months	None

Authors (year)	Male: Female	Age (average)	Treatment*
Ko et al. (2000) ²¹	20:25	17–77 (45.3)	Acyclovir IV 1,5g/d 5–13 days Prednisolone O 60mg/d 7 days + reduction
Uri et al. (2003) ²²	12:19	6–77 (50.8)	Acyclovir IV 5mg/kg 3t/day 7 days Hydrocortisone IV 300mg/d 7 days
Yeo et al. (2006) ²³	16:10	(41.4) SD 19.4	Acyclovir IV 5mg/kg 3t/d 5 days + Famciclovir O 1,5g/d 7 days Prednisolone O 1mg/kg/d 5 days + reduction
Kim et al. (2010) ¹³	7:4	19–76 (51.5)	Acyclovir IV 750mg - 4,8g/d 5–12 days Prednisolone O 40-60mg + reduction 10–37 days
Coulson et al. (2011) ²⁴	70:31	11–85 (49.4)	Acyclovir O 1g/d or Famciclovir O 750mg/d 21 days Prednisone O 1mg/kg/d 14 days + reduction
Ryu et al. (2012) ²⁵	70:85	(47.2) SD 16.5	Acyclovir O 2,4g/d 5 days Methylprednisolone O 80mg/d 4 days + reduction
Byun et al. (2013) ²⁶	12:10	11–82 (55)	Acyclovir or Famciclovir O 7 days Corticosteroid* O 1mg/kg/d 7 days + 4 days reduction
Shin et al. (2015) ²⁷	42:39	19–89 (47.7)	Not included
Cai et al. (2017) ²⁸	12:11	(54.43) SD 15.28	Acyclovir O 600mg/d 7-10 days Prednisone O 30mg/d 5 days + 5 days reduction
Kim et al. (2019) ²⁹	40:66	(44.98) SD 16.37	Famciclovir O 750mg/d 7 days Corticosteroid** O 80mg/d 4 days + reduction
Kanerva et al. (2020) ¹⁴	49:71	6.9–94.7	Valaciclovir O 3g/d 7 days**** Prednisolone 60mg/d 5 days + 5 days reduction
Rim et al. (2023) ³⁰	103:89	(51.3–43.2) SD 19.2–13.1	Prednisolone O 1mg/kg/d + reduction Famciclovir O 750mg/d 7 days

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[TFN1] Abbreviations: DM, Diabetes Mellitus; SAH, Systemic Arterial Hypertension; VZV, patients identified as positive for the Varicella-Zoster virus in each study.

[TFN2] ^*
Polyneuropathy – involvement of any cranial nerve other than the VII nerve.

[TFN3] ^**
Higher initial grade is associated with a more favorable prognosis.

[TFN4] ^***
Cited by the authors as factors, without disclosing statistics.