Acute unilateral vestibular loss as onset of zoster oticus infection

Case report A 53-year-old man presented at the emergency room with severe vertigo, vomiting and disequilibrium. Based on bed-side otoneurological evaluation and audiometry, we considered a case of vestibular neuritis (usually herpes simplex infection) and we immediately started intravenous treatment with cortisone, vestibular suppressants and betahistine. Unfortunately, after two days, patient developed ipsilateral peripheral facial palsy, ipsilateral sensorineural severe hearing loss and hyperglycaemia. Patient was included in an antidiabetes treatment protocol. We considered at that later moment the infection as a herpes zoster infection (herpes zoster oticus or auricular herpes zoster, Ramsay Hunt syndrome) and we continued intravenous administration of vasodilators and group B vitamins, but without cortisone due to hyperglycaemia. Facial palsy recovered slowly but completely as well as dizziness (4 month), but this was not the case with the hearing loss.