The changing face of petrous apicitis—a 40‐year experience

Gadre, Arun K.; Chole, Richard A.

doi:10.1002/lary.26571

Cited by 55 publications

(92 citation statements)

References 25 publications

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“…Regarding the choice of antibiotics for treatment of GS, most authors advocate for the use of a cephalosporin antibiotic along with metronidazole with or without the addition of vancomycin [10,11]. Empirical intravenous antibiotics should cover common agents involved in bacterial mastoiditis (Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, and Pseudomonas aeruginosa) and anaerobic organisms can also be considered [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…e patient was diagnosed with GS based on her clinical presentation, which included acute suppurative otitis media with involvement of the sixth cranial nerve, and based on the evidence of petrous apicitis (apical petrositis) on the CT. e imaging studies also revealed the presence of cavernous sinus thrombosis and carotid septic stenosis. Other differential diagnosis of petrous apicitis including congenital cholesteatoma, intracranial abscess, lateral sinus thrombosis, cholesterol granuloma, temporal bone osteomyelitis, and neoplastic or granulomatous disease were excluded according to the clinical and radiological presentation [10,11].…”

Section: Case Presentationmentioning

confidence: 99%

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Gradenigo’s Syndrome with Carotid Septic Stenosis

Menezes

Ribeiro

Balona

et al. 2020

Case Reports in Otolaryngology

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Gradenigo’s syndrome was firstly described in 1907 by Giusseppe Gradenigo and is defined as the clinical triad of suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the first and the second branches of the trigeminal nerve. Since the advent of antibiotics, the incidence of this potentially life-threatening complication has diminished, but occasional cases still occur. We herein report a pediatric case of otitis media associated with Gradenigo’s syndrome complicated by ipsilateral septic cavernous sinus thrombosis and infectious arteritis of the internal carotid artery.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Gradenigo’s Syndrome with Carotid Septic Stenosis

Menezes

Ribeiro

Balona

et al. 2020

Case Reports in Otolaryngology

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“…Due to its rarity, the incidence in adults is largely unknown. 1,5,7 Here, we describe a case of petrous apicitis that presented as chronic migraine without aura in a man with chronic otitis media/externa who underwent mastoidectomy with tympanoplasty. 2 Due to the close proximity of the petrous apex to neurovascular structures including the trigeminal ganglion, abducens nerve, and facial nerve, petrous apicitis can lead to neurovascular compromise and corresponding symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…1 The incidence in infants and children, however, has been reported as 2/100,000. It is a known complication of acute otitis media, as acute otitis media can extend medially into a pneumatized petrous apex.…”

Section: Introductionmentioning

confidence: 99%

Headache in Petrous Apicitis: A Case Report of Chronic Migraine‐like Headache Due to Peripheral Pathology

et al. 2019

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Objective To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. Background Petrous apicitis is a rare complication of acute otitis media with varied clinical presentations that stem from the close proximity of the petrous apex to numerous neurovascular structures. Headache is among the common symptoms of petrous apicitis. Methods A case of new onset headache in the setting of petrous apicitis with symptomatic response to antibiotic therapy was reported. We provided a brief review of peripheral pathophysiological mechanisms of migraine and correlated to mechanism of headache in petrous apicitis. Results A 65‐year‐old man with chronic otitis externa/media presented with ongoing headache fulfilling International Classification of Headache Disorders 3rd edition (ICHD‐3) criteria for chronic migraine without aura that persisted despite undergoing right mastoidectomy and tympanoplasty with multiple courses of oral antibiotic therapy for his chronic otitis. MRI brain revealed petrous apicitis, otomastoiditis, and clival osteomyelitis. His imaging findings improved and his migraine‐like headache completely resolved after treatment with a prolonged course of antibiotics. Conclusions Petrous apicitis can present as a headache with features of migraine, and in this case in particular, as chronic migraine without aura. The pathophysiological mechanisms that may underlie the generation of migraine‐like headache in petrous apicitis may include the activation of nociceptive fibers within the periosteum of the petrous apex and clivus whose cell bodies originate in the trigeminal ganglion and upper cervical dorsal root ganglia. By treating the peripheral pathology, resolution of the headache may be achieved.

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“…Simultaneous clinical presentation with all three components of the triad, however, is less common in the literature [ 4 ], particularly in the era of widespread vaccination and use of antibiotics effective against typical organisms causing acute or chronic OM and subsequent petrous apicitis. Some reported cases of GS lack the triad's otic symptoms and are described as incomplete or nonclassical presentations [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Gradenigo’s Syndrome and Bacterial Meningitis in a Patient with a Petrous Apex Cholesterol Granuloma

Hodges

Matsumoto

Jaeger

et al. 2020

Case Reports in Infectious Diseases

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Gradenigo’s syndrome (GS) classically involves a triad of ear pain due to acute or chronic otitis media (OM), facial or retro-orbital pain in the distribution of the trigeminal nerve, and an abducens nerve palsy. The simultaneous presentation of all three components has become less common in cases of GS reported in the literature, particularly in the era of antibiotics effective against typical organisms attributed to OM and petrous apicitis. In addition to infectious petrous apicitis arising directly from OM, more recent cases of GS are attributed to the compression of the same traversing cranial nerves in the presence of various expansile petrous apex (PA) lesions, both benign and malignant. We report a case of a 24-year-old male who presented initially with nausea, fever, photophobia, left-sided retro-orbital pain, and headache. He was diagnosed with bacterial meningitis by lumbar puncture and treated with empiric antibiotics, with CSF eventually revealing nontypeable Haemophilus influenzae. Several days into his course, he developed diplopia with leftward gaze. Brain imaging revealed an expansile, erosive PA cholesterol granuloma with associated contiguous dural and leptomeningeal enhancement. The patient improved with antibiotics and eventually underwent surgical intervention. This atypical presentation of GS with a rare complication of meningitis in the setting of a PA granuloma demonstrates the importance of early recognition of this syndrome, as well as consideration of added surgical intervention in patients with pre-existing petrous lesions at potentially higher risk of dangerous complications of GS.

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The changing face of petrous apicitis—a 40‐year experience

Abstract: 4. Laryngoscope, 128:195-201, 2018.

Cited by 55 publications

References 25 publications

Gradenigo’s Syndrome with Carotid Septic Stenosis

Gradenigo’s Syndrome with Carotid Septic Stenosis

Headache in Petrous Apicitis: A Case Report of Chronic Migraine‐like Headache Due to Peripheral Pathology

Gradenigo’s Syndrome and Bacterial Meningitis in a Patient with a Petrous Apex Cholesterol Granuloma

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