In 1904 Gradenigo 1 described a triad of symptoms which has since been called Gradenigo's syndrome. It consists of acute otitis media, associated with pains in the head and paralysis of the sixth, or abducens, nerve, both of which occur on the same side as the aural condition. The pathologic condition of the ear may take the form of acute purulent otitis media or an exacerbation of chronic otitis without signs of mastoiditis, or the syndrome may occur during convalescence from an operation on the mastoid. The pains in the head, due to pressure on the gasserian ganglion, are as a rule severe, and may be occipital, temporoparietal, in or around the eye or referred to the teeth. As a result of the involvement of the sixth nerve (which, like that of the fifth nerve, is the effect of pressure exerted on the nerve by localized serous meningitis