Thursday, April 28, 2016

I Encounter a Rare Disease

A man suffered a headache on his flight. After arriving at the hotel, his left ear began hurting and soon became excruciating.

When he opened the door, I noticed that the left side of his face drooped.

Nothing pointed to the usual ear infection. He had no cold symptoms. The plane’s descent did not aggravate symptoms. He didn’t swim or use q-tips. He did not have a fever.

When I looked inside the ear canal, I saw blisters.

Painful blisters in the canal and a droopy face….  In forty years of practice, I have never seen a case of Ramsay-Hunt syndrome, but there it was. The poor man had shingles inside his ear.

Shingles is a viral infection of skin nerves. It’s fairly common and usually appears as a patch of blisters on the chest, abdomen, or back, sometimes the face. But there is skin in your ear canal. An additional complication occurs because the nerve supplying the ear canal also feeds muscles of the face, so victims suffer facial weakness on that side.

Treatment is an antiviral drug and a course of cortisone which is modestly but not dramatically effective. Chances are he would recover completely, but he would have an uncomfortable few weeks.

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