You read that right. Shingles – that painful rash and blisters that’ll turn crusty can pop up right on your ear. Your EAR. I have worked in the hospital setting for fifteen years, seen numerous cases of shingles almost everywhere, but never just the ear. Now, after dealing with the aftermath of this for a month and finally feeling like there is a light at the end of the tunnel, I want to make sure everyone realizes what the wrath of shingles can do, how to recognize it and even how to prevent it.
What is Shingles?
Remember chicken pox? That childhood right of passage usually brings back memories of itching and pink calamine lotion dotted on the spots with cotton balls. Well, I had it over Easter sometime in the early 1980s. That’s all I really remember about it, some itching, cotton balls and pretty sure my brother and possibly cousins also caught it.
Since I had the chicken pox, or the varicella-zoster virus, back in the 1980s, I am now at risk for having shingles.
Shingles referred to as the herpes zoster virus, and is just the reactivation of the dormant chickenpox virus. My little Easter holiday illness back in the 1980s decided that post-2020 pandemic was a great time to revisit me.
Same virus, kinda an encore performance. However, you might have good memories of having the chicken pox, like I did, but trust me, this virus is not in a “oh, I can’t wait to see you again and catch up” mood.
Instead of the little “spots” with chicken pox following a few days of fever, malaise and loss of appetite; the shingles usually starts with pain, followed by a rash, and a list of potential complications.
Four Weeks and Counting
It all started with some mild ear pain.
Late last summer, I had bit of cellulitis on the same ear lobe. Since I had just started wearing a different pair of earrings in mid-January, I assumed that the infection recurred. This was my mistake, assuming it was one thing. Because of this, I am going to be the first to admit, I missed my own diagnosis.
The last Sunday in January is when it all started to go awry. Chicago had a wee bit of snow, so our plan was for the adults to build a snow troll while the kids went sledding. Hat snug over my head, I pressed on in the snow. I felt tired, my ear ached and I was even a tad unsteady but it had been a busy week. I had assumed I just overdid it.
Monday, at work, I brought my otoscope and had the other NP examine my ear. It’s literally the one part of your body you really can’t examine yourself. It still didn’t feel right, but also nothing horrible. While I had some fluid on the other ear, my left ear looked pretty good. No redness, no warmth, nothing looked out of the ordinary. Still, with the intermittent discomfort and the infection from last summer still on my mind, I made an appointment to see the ENT (ear, nose and throat doctor) on Thursday. Our guess was still that I had an infection brewing.
Later that evening, the pain got worse. Not just a little uncomfortable – it was utter madness. My ear felt like it was on fire. Not wanting to irritate it more by touching it, I just positioned myself on the couch and tried to tough it out. My thinking was if it was an infection it would get better my the morning after the antibiotics.
The next morning, Tuesday, is when it all went bad. I sat up in bed and started walking around and was immediately dizzy. Not the “got out of bed too quick” dizzy but “why the hell is the entire house moving” dizziness. I reached out to my ENT again, as well as my primary doctor office because this was way outside the realm of an ear infection. Something was wrong. The dizziness was so bad I needed my husband to head home from work because I couldn’t manage a house of kids zooming, plus try to drive myself to the doctor.
The first to call me back was the ENT. I was so happy to hear the voice of a doctor, but then the first words out of his mouth was “You sound like you have shingles”. My first reaction was “no way” as this didn’t even cross my mind of things that could be wrong. Then I started to reflect at everything I was complaining about, onset of symptoms, location, intensity….and was like, holy hell, I have shingles.
The tricky part of shingles is the medication treatment. You need to start the medication, usually valacyclovir, within 72 hours of rash onset, and the maximum efficacy is within 48 hours. It was Tuesday morning, and I had started feeling something brewing on Sunday. We were at least at 48 hours, if not more. At this point there was no rash that I could see, but again, it is really not like you can look in your own ear!
I started the medications within about two hours of those morning calls, and went to the office later that afternoon for an exam. By later that afternoon, the rash/blisters had started to form on lower inside of my left ear. If there was any doubt, it was all erased by the rash finally making an appearance.
For the next week, and two office visits, the plan was medications and monitoring. Valacyclovir and prednisone (starting at 60mg daily) for the next two weeks with tapering the dose was the plan. The worry was that with the location of the shingles (the ear) on how it could affect the cranial nerves. The plan was for close monitoring and reporting any new symptoms immediately. I had a hearing test done and at the left ear already had some hearing loss. Again, we were hopeful this would improve as the medications did their thing.
Initially, things were looking pretty good. The pain was minimal, and overall tolerating the medications well.
Then, during the second week. over a few days, each and every symptom of Ramsey Hunt, the complication associated with shingles with otic (ear) involvement started to surface:
- Vertigo, dizziness throughout the day. While it has been consistent the entire time, it ranges from barely noticeable to needing to just give up and take a nap hoping it will stop.
- Facial weakness – all on the left side (think “Bells Palsy”). This affected my ability to drink and eat (straws and spoons were not my friend).
- Dry eye from lack of blinking. My left weakness affected my blinking. Eyedrops were used throughout the day on a very consistent basis.
- Excess Tearing. After about a week, then I had the complete opposite issue, where my left eye was tearing uncontrollably.
- Taste alternation. Nothing tasted right, had a metallic taste to it or no taste at all. This also included a bit of numbness, almost like after the dentist and the novocain has almost worn off – but it lasts like that for days.
- Hearing Loss: everything on the left side was muffled, feeling like my ear was clogged.
- Pain: thankfully, while present at times, overall any discomfort has been short and minimal.
There is no overall treatment for this, but thankfully the increase in prednisone helped. This was done after the facial weakness worsened, and finally finished the steroid taper at the end of February. I also had an MRI that did show some inflammation of the cranial nerve around the left ear, and plan a followup MRI in three months hoping it to be resolved.
Don’t Delay: Vaccination
That all sounds pretty bad, something you want to avoid, and you might be wondering what you can do.
First – if you are over the age of 50 – GET YOUR SHINGLES VACCINE. The older you get, the risk for shingles occurring as well as the complications of post-herpetic neuralgia (PHN) increases. PHN is the pain that lasts well after the rash is gone, and from what I have read, the pain can be extreme. Thankfully, I seem to be in the clear for that right now.
Since I am the “youngest” of most all my friends, every time one of them turns 50 I will write a little note in their birthday card to schedule the shingles vaccine. I might even write it in the Christmas cards this year, a little vaccine reminders to everyone.
Currently, the vaccine recommended is Shingrix, and is administrated as two doses, about 2-6 months apart. While there are the side effects associated with the vaccine (you could feel pretty crappy for a few days), after the second dose the vaccine is 90% effective in preventing shingles and its complications. I would totally take those two days post-vaccine over my twenty seven days and counting of shingles recovery. More info on the vaccine can be found here, on the CDC website.
Know the Signs and Symptoms
If you are under 50, that’s where the catch-22 comes in. You need to be aware of the signs and symptoms of shingles so there is no delay in diagnosis. That is key – time is crucial to start the anti-viral medications that helps shorten the severity of shingles. Here are some key points:
- Pain usually comes before the rash. This pain is usually in ONE area on ONE side of the body.
- Pain/rash is usually located on specific dermatomes, and usually in a stripped pattern (again, only on one side of the body)
- Pain is unique and usually described as burning, stabbing. throbbing. It can “come and go” but usually pretty persistent.
- Most concerning areas for this to occur are the face, near the eyes, and around the ears. The complications from the nerve involvement in these areas can be severe, and even threaten your vision and/or hearing.
- Once the rash appears, in the same area as the pain, this is when you must call your provider.
Can you spread Shingles?
You cannot spread or catch shingles. However, what you can do is spread the virus that causes chickenpox (varicella) to those who have never had it before. Think of grandparents around grandchildren who have yet to receive their varicella vaccination, or to those who cannot receive vaccinations.
This is why once you have shingles and the rash appears, you should avoid contact with others until the rash has “crusted” over. If it is in an area that is easily covered, that does make it easier to lessen any transmission risk.
Thankfully, most people do recover, and quickly from shingles, usually within a few weeks. Most treatment includes a 7-10 days of valacyclovir. Following that, any side effects from shingles are treated as needed. This can be a combination of medications or therapy.
For myself, I’m hopeful that the vertigo continues to improve. I only needed one nap each day this weekend, and that pain continues to be non-existent. So far, starting week five following diagnosis, all but the vertigo has improved significantly. Hopefully the next 2-3 weeks, all symptoms will resolve. Hopefully.
I do plan, after a few more weeks, to ask for the shingles vaccine. While I am still five years away from 50, this isn’t a “one and done” type virus and shingles could occur again. I am not taking any chances, and will raise my sleeve for the vaccination as soon as I can!