Acute Otitis Media-Induced Gradenigo Syndrome, a Dramatic Response to Intravenous Antibiotic

Document Type : Case Report

Author

Otolaryngology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Introduction:
Petrositis is a rare but severe complication of acute otitis media and mastoiditis. Despite efficient antibiotic therapy, there are still reports of both intratemporal and intracranial complications of otitis media with the potential risk of high morbidity and mortality. Petrositis has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow more conservative management.
 
Case Report:
In this case report we describe the clinical course and treatment of a 33-year-old man with petrous apicitis who presented with severe otalgia, retro-orbital pain, and sixth cranial nerve palsy Gradenigo syndrome. Our patient showed a dramatic response to intravenous antibiotics only, without need for any surgical intervention, even myringotomy.
 
Conclusion:
It seems that early detection and management of this syndrome before development of other intratemporal or intracranial complications may prevent the need for surgical intervention.

Keywords

Main Subjects

References

1. Loretan S, Duvoisin B, Scolozzi P. Unusual fatal petrositis presenting as myofascial pain and dysfunction of the temporal muscle. Quintessence int. 2011; 42(5): 419–22.
2. Plodpai Y, Hirunpat S, Kiddee W. Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report. J Med Case Rep. 2014; 8:217.
3. Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg. 1998;119(5):444–54.
4. Flint PW, Lund VJ, Niparko JK, Richardson MA, Robbins KT, Thomas JR. Cummings Otolaryngology – Head & Neck surgery. Fifth ed. Philadelphia: Mosby Elsevier 2015. p2963.
5. Lutter SA, Kerschner JE, Chusid MJ. Gradenigo syndrome: a rare but serious complication of otitis media. Pediatric Emergency Care. 2005; 21(6): 384–6.
6. Choi KY, Park SK. Petrositis with Bilateral Abducens Nerve Palsies complicated by Acute Otitis Media. Clin Exp Otorhinolaryngol. 2014; 7(1): 59–62.
7. Chen PY, Wu CC, Yang TL, Hsu CJ, Lin YT, Lin KN. Gradenigo syndrome caused by nontuberculous mycobacteria. Audiology Neurootology. 2014; 19(4): 275–82.
8. Bhatt YM, Pahade N, Nair B. Aspergillus petrous apicitis associated with cerebral and peritubular abscesses in an immunocompetent man. J Laryngol Otol. 2013;127(4):404–7.
9. Rossor TE, Anderson YC, Steventon NB, Voss LM. Conservative management of Gradenigo's syndrome in a child. BMJ Case Reports. 2011; 2011.
10. Valles JM, Fekete R. Gradenigo syndrome: unusual consequence of otitis media. Case Reports in Neurology. 2014;6(2):197–201.
11. Hananya S, Horowitz Y. Gradenigo syndrome and cavernous sinus thrombosis in fusobacterial acute otitis media. Harefuah. 1997;133(7-8): 284- 6, 335.
12. Kong SK, Lee IW, Goh EK, Park SE. Acute otitis media-induced petrous apicitis presenting as the Gradenigo syndrome: successfully treated by ventilation tube insertion. Am J Otolaryngol. 2011; 32(5): 445–7.
13. Scardapane A, Del Torto M, Nozzi M, Elio C, Breda L, Chiarelli F. Gradenigo's syndrome with lateral venous sinus thrombosis: successful conservative treatment. Eur J Pediatr. 2010; 169(4): 437–40.
14. Homer JJ, Johnson IJ, Jones NS. Middle ear infection and sixth nerve palsy. J Laryngol Otology. 1996; 110(9):872–4.
15. Chole RA, Donald PJ. Petrous apicitis. Clinical considerations. Annals Otology Rhinol Laryngol. 1983; 92(6 Pt 1):544–51.
16. Watkyn-Thomas FW. The Treatment of Petrositis: (Section of Otology). Proceedings of the Royal Society of Medicine. 1936; 29(3):267–74.
17. Hendershot EL, Wood JW, Bennhoff D. The middle cranial fossa approach to the petrous apex. Laryngoscope. 1976;86(5):658–63.
Iranian Journal of Otorhinolaryngology
Volume 29, Issue 3 - Serial Number 92
May and June 2017
Pages 165-169

Files

Share

How to cite

Statistics