Gradenigo’s syndrome as a rare complication of acute otitis media in a child – case study

Abstract

Gradenigo’s syndrome (GS) is a rare complication of otitis media and is defined as a concomitant unilateral acute inflammation of the middle ear, facial pain in the region supplied by the trigeminal nerve and abducens nerve palsy. It occurs in less than 2 in 100 thousand cases of acute otitis media. Cavernous sinus thrombosis (CST) is a rare complication usually accompanying sinusitis, however a few cases of CST in the course of GS were described before. We present a case of a 11-year old boy with a history of otitis media admitted to the Department of Pediatric Otolaryngology of a tertiary care center with vomiting, headache, unilateral paresthesia of the face and diplopia. Cavernous sinus thrombosis as well as inflammation of the temporal bone including the petrous apex with formation of a subperiosteal abscess was shown in CT and MRI scans. The patient was treated with ceftriaxone, metronidazole and vancomycin, as well as enoxaparin and warfarin. Antromastoidectomy of the right temporal bone was performed. The patient recovered gradually over the course of treatment with a complete resolution of CST in MRI and abducens nerve palsy after in clinical examination after 11 weeks of treatment. Even though both Gradenigo’s syndrome and cavernous sinus thrombosis are rare entities the knowledge of their clinical manifestations is very helpful for both laryngologists, pediatricians and general practitioners. Early diagnosis and prompt introduction of treatment are crucial for successful treatment and avoiding dangerous sequelae.