Introduction: Gradenigo's syndrome is a rare complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. This syndrome is characterized by a clinical triad of deep facial pain, sixth cranial nerve palsy, and acute otitis media (AOM). Case report: We report a case of a six-year-old girl, with no past medical history, who presented with a sudden diplopia following six days of headache and otorrhea. The diagnosis of gradenigo's syndrome was confirmed by clinical examination and imaging. She made a full recovery after 9 weeks of antibiotics. Discussion: Gradenigo's syndrome is a rare but life threatening complication of AOM. The inflammatory process starts in the middle ear, and spreads from the base to the top of the petrous portion of the temporal bone, producing several diagnostic symptoms. Careful clinical history and physical examination, including imaging, are necessary to make the diagnosis. Appropriate management requires antibiotic treatment and possible surgical intervention.