title: Pharyngolaryngeal involvement by varicella-zoster virus.
abstract: BACKGROUND
  Involvement of cranial nerves V, VII, and VIII by varicella-zoster virus (VZV) is widely reported in the literature, whereas involvement of cranial nerves IX and X is rarer and therefore poorly characterized.
  
  
  METHODS
  We performed a systematic review of the literature through MEDLINE (up to January 2012). We selected cases reporting pharyngolaryngeal involvement by VZV and extracted clinical features, complementary studies, treatments, and outcome. We added three cases to the existing literature.
  
  
  RESULTS
  Of the 65 screened articles, 38 were included reporting 54 cases. The main clinical features were odynodysphagia and dysphonia reflecting underlying hemipharyngolaryngeal palsy. Vesicles were seen in 66% of the patients. Besides the involvement of cranial nerves IX and X, concomitant involvement of other cranial nerves was seen in 48% of the cases. The most concerned nerves were cranial nerves VII and VIII. Virological tests (63%) and imaging (28%) were performed, with the latter being systematically normal. Seventy-two percent of patients were treated with antiviral agents and/or corticosteroids. Twenty-six percent of patients made a full recovery while the remaining had some persistent deficits. We did not find statistically significant differences in outcomes according to age or treatments received.
  
  
  CONCLUSIONS
  Pharyngolaryngeal involvement by VZV is rare and seldom restricted to the ninth and tenth cranial nerves. It occurs mostly within the context of cranial polyneuropathy. Regardless of the treatment, full recovery is rare and long-term sequelae persist in many cases, especially with speech and swallowing impairment. Close monitoring and follow-up are therefore essential.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland. llnisa@yahoo.ca
authors.forename: Lluís
authors.initials: L
authors.lastname: Nisa
authors.forename: Basile Nicolas
authors.initials: BN
authors.lastname: Landis
authors.forename: Roland
authors.initials: R
authors.lastname: Giger
authors.forename: Igor
authors.initials: I
authors.lastname: Leuchter
mesh_terms: D000368:Aged; D005260:Female; D005930:Glossopharyngeal Nerve / Q000821:virology*; D006562:Herpes Zoster / Q000503:physiopathology*; D014645:Herpesvirus 3, Human; D006801:Humans; D007818:Laryngeal Diseases / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000821:virology*; D014630:Vagus Nerve / Q000821:virology*
keywords: Cranial polyneuropathy; Deglutition disorders; Glossopharyngeal nerve; Speech disorders; Vagus nerve; Varicella-zoster virus