Some readers may be surprised at today’s topic and wonder what shingles has to do with hearing loss or balance problems. Shingles is a huge topic on its own, not to mention how it affects hearing and balance. Today’s post is a Q&A overview. Future posts will be more specific about shingles, hearing, and balance problems.
What are Shingles?
Shingles, also known as herpes zoster, is a viral infection caused by the varicella-zoster virus. It occurs exclusively in individuals who have previously had chickenpox.
While shingles may sound like a plural term, it is singular and refers to the reactivation of the dormant varicella-zoster virus. Below, we will explore the differences between chickenpox and shingles, delve into the nature of shingles, discuss its symptoms, and touch upon prevention methods.
Image credit: CDC
Differentiating Chickenpox and Shingles
Previously considered separate diseases, chickenpox and shingles are now known to be caused by the same varicella-zoster virus. Chickenpox, also known as varicella, is the primary infection of the virus and primarily affects children. It is highly contagious, spreading through airborne transmission and resulting in rashes over the entire body.
Doctor inspects child with chickenpox
In contrast, shingles occurs when the dormant varicella-zoster virus reactivates in individuals who have had chickenpox. The two disorders can affect the same nerves, leading to skin lesions and rashes in both cases.
Chickenpox is a disease of childhood (75-90% of cases in children under 10) that manifests in rashes over much of the body. The rashes are very itchy but rarely painful. That’s because children’s immune systems are “naive”–they lack a prepared immune response to launch an all-out war on the virus.
Understanding Shingles: The Awakened Monster
Shingles can be perplexing because it manifests after the supposed resolution of chickenpox. The varicella-zoster virus remains in the body throughout life, literally hides in plain sight from the immune system, tucked away in cranial nerves and nerve bundles in the body called dorsal root ganglia which transmit sensory information from the skin to the brain.
How do you Get Shingles? Transmission and Reactivation
Only individuals who have previously been infected with the varicella-zoster virus can develop shingles. If one has not had chickenpox, they cannot contract shingles, but they can still develop chickenpox if exposed to someone with shingles.
The reasons behind the reactivation of the virus are still not fully understood.
How do I keep the virus asleep? Nobody knows why the virus gets restless (“reactivates”) in some people and not in others.
What reactivates the virus? It’s an equal opportunity monster as far as gender, race, and seasonality go. But, reactivation is more common as we age; also in people with immune systems that are compromised by a variety of factors (e.g., HIV-positive, cancer, immunosuppressant drug treatments). Table 1 gives a few statistics.
What happens when the virus reactivates and manifests as shingles? The virus leaves home and spreads through the ganglion and nerves, especially those innervating the face and body trunk. It can even invade the spinal cord and bloodstream.
Symptoms and Effects
Shingles is characterized by the eruption of a painful rash consisting of small blisters. These blisters follow the path of the nerves on which the virus has settled, often forming a band-like pattern on the skin. The blisters continue to develop for up to five days and eventually pop, ooze, crust, and heal over a period of 3-4 weeks.
Throughout this time and sometimes for months afterward, individuals may experience:
- Continuous burning or aching pain
- Periodic piercing pain
- Spasm similar to electric shock
These symptoms can be more debilitating than regular pain and may be triggered by even the slightest touch, temperature changes, or cold wind. Some individuals may continue to experience these symptoms for months after the initial outbreak.
Prevention and Vaccination
While there is no cure for shingles, a vaccine called Shringrix is available for individuals aged 50 and older.
The Shingrix vaccine is recommended for adults aged 50 and older, with two doses administered 2 to 6 months apart. It is also recommended for individuals 19 years and older with weakened immune systems. Even if you have had shingles in the past or have received other vaccines, it is still advisable to receive the Shingrix vaccine for prevention, and there is no maximum age limit for getting vaccinated.
Impact on Hearing and Balance
Shingles can affect the vestibulocochlear nerve, potentially leading to hearing and balance issues. Depending on the path the virus takes within the nerve, different consequences may arise.
The impact of shingles on hearing and balance will be further explored in Part 2 of the Shingles Series.
References: in addition to the links shown in the text information was pulled from a variety of sources including a Q&A and an In-depth Report in the NYTimes and Q&A at Yahoo and medicinenet.
As a long time (March 2008) survivor of Ramsay Hunt Syndrome I am looking forward to reading your upcoming articles. I, like many RHS’ers, am left with disabling balance/dizziness issues. Originally misdiagnosed with cellulitus and Bell’s Palsy, I never did receive the Shingles strength of antivirals (I was seen at three different ER’s and then my local docs). I suspect that if I did my residuals would not be so severe. This is a common problem, even today. Most doctors don’t know what RHS is or how to treat it. To make matters worse, standard VT and hearing aids don’t seem to help us. When to start facial therapy, acupuncture, vitamin supplements, use of TENS, surgeries all seem to be trial and error. I was lucky, my hearing has returned to normal limits but I still have difficulty understanding some female voices (I had sensorineural loss). There are many who have become deaf on their RHS side with no relief. Seeing a Neurotologist seems to be our best shot at recovery, most other specialities just don’t understand our issues.
I anxiously await your series and thank you for bringing this subject to light.