Gradenigo's syndrome in a four-year-old patient: a rare diagnosis in the modern antibiotic era

Abstract

ObjectiveThis study gives details of a rare case of petrous apicitis that presented as Gradenigo's syndrome and was managed surgically.MethodThis study presents a case report and review of the literature.ResultsA four-year-old female was admitted for failure to thrive following recent sinusitis. Physical examination was positive for right sided facial pain, photophobia and right abducens nerve palsy. Subsequent magnetic resonance imaging revealed a 1.3 × 1.7 × 1.4 cm abscess encompassing the right Meckel's cave. A computed tomography scan showed petrous apicitis and otomastoiditis, confirming Gradenigo's syndrome. The patient was taken to the operating theatre for right intact canal wall mastoidectomy with myringotomy and tube placement. She was discharged on six weeks of ceftriaxone administered by a peripherally inserted central catheter line. At a two-week post-operative visit, she showed notable improvement in neuropathic symptoms.ConclusionThis study presents a rare case of petrous apicitis managed surgically without the need for a craniotomy or transcochlear procedure.

Delayed diagnosed Gradenigo’s syndrome associated with acute otitis media

“…Streptococcus pneumoniae, beta hemolytic Streptococci, Staphylococcus spp., Haemophilus influenzae, Pseudomonas spp., Moraxella catarrhalis, and various anaerobes are known to cause otitis media. 2,4 In our patient, although the aspirate from the ventilation tube insert was cultured, the results were negative. Gadre and Chole 4 reported 15 positive cases on examination of 44 patients.…”

“… 4 CT can help to determine the bone structure, while MRI can identify the cranial involvement. Although inflammatory pseudotumor, sarcoidosis, tuberculosis, intracranial abscess, lateral sinus thrombosis, Tolosa-Hunt syndrome, and malignancy have been reported as the differential diagnoses of petrous apicitis, 2 neurological diseases should also be considered in the differential diagnosis because of retroorbital pain and abducens palsy when ear examination is not performed, such as in our case.…”

“…Leakage of cerebrospinal fluid, cerebral edema, increased intracranial pressure, pneumocephalus, and seizures are the possible complications of surgery. 2 In view of these complications, ventilation tube insertion is less invasive procedure. Moreover, surgical drainage of the mastoid or the insertion of a ventilation tube is recommended in selected cases unresponsive to conservative management.…”

“…Although the disease is diagnosed with this triad, clinically, 13.6%-42.1% of patients with petrous apicitis present with the classical triad. 2 Although the incidence of Gradenigo's syndrome has decreased to 2 per 100,000, its treatment and management strategies remain unclear. 3 Some clinicians prefer surgical intervention because of 2.3% patient mortality due to petrous apicitis.…”

Gradenigo’s Syndrome with Carotid Septic Stenosis

“…e ideal treatment for petrous apicitis is controversial and typically depends on the severity of clinical presentation [14]. Recently, some authors have advocated for nonsurgical intervention with intravenous antibiotic therapy [15].…”