Abstract
Background Extracranial intratemporal complications of chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo's syndrome is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. Case Report A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. Conclusion Although there is little evidence to support the use of conservative treatment in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome.
Highlights
Chronic suppurative otitis media (CSOM) is characterized by recurrent or persistent ear discharge over 12 weeks through a perforation of the tympanic membrane [1].e complications of chronic suppurative otitis media (CSOM) have been greatly reduced because of the development of antibiotics
Different prevalence rates for extracranial complications of CSOM have been reported to date [2,3,4]. ere are still a number of patients, who develop acute mastoiditis, subperiosteal abscess, facial palsy, and intracranial complication due to recent increase of antibiotic-resistant bacteria [5], and other very rare complications like labyrinthitis and petrositis are encountered
Gradenigo’s syndrome (GS) is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. e syndrome is an exceedingly rare complication of CSOM in the era of the widespread use of antibiotics and accessible health-care services
Summary
Extracranial intratemporal complications of chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo’s syndrome is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. E patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. There is little evidence to support the use of conservative treatment in the treatment of Gradenigo’s syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo’s syndrome
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