Keywords
Otitis Media
Pediatrics
Conservative Treatment
Abducens Nerve Diseases
Gradenigo's Syndrome
How to Cite
Abstract
Gradenigo’s syndrome is a rare entity in the modern era with less than 50 cases reported in the pediatric population in the last 50 years. The clinical triad consists of acute otitis media, abducens nerve palsy and pain in the ophthalmic division of the trigeminal nerve. Treatment is controversial since there are no high quality studies that support an specific management. Although traditionally the management was surgical, the current trends in case reports implies a conservative treatment with early antibiotics that may avoid the risks of a surgical procedure. We present the case of a 7-year-old patient with an acute otitis media complicated with a Gradenigo’s syndrome that was successfully managed with endovenous antibiotics (ceftriaxone and vancomycin), supporting with this case the current trends of treatment.
References
Jamal A, Alsabea A, Tarakmeh M, Safar A. Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children. Cureus. 2022;14(8): e28019.
Cassano P, Ciprandi G, Passali D. Acute mastoiditis in children. Acta Biomed. 2020;91(1-S):54-59.
Mattos JL, Colman KL, Casselbrant ML, Chi DH. Intratemporal and intracranial complications of acute otitis media in a pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78(12):2161-2164.
Rossi N, Swonke ML, Reichert L, Young D. Gradenigo’s syndrome in a four year-old patient: a rare diagnosis in the modern antibiotic era. J Laryngol Otol. 2019;133(6):535-537.
Gradenigo G. Über die paralyse des nervus abducens bei otitis. Archiv f. Ohrenheilkunde. 1907;74:149-187.
McLaren J, Cohen MS, El Saleeby CM. How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigo's syndrome. Int J Pediatr Otorhinolaryngol. 2020;132:109942.
Demir B, Abuzaid G, Ergenc Z, Kepenekli E. Delayed diagnosed Gradenigo's syndrome associated with acute otitis media. SAGE Open Med Case Rep. 2020;8:2050313X20966119.
Fournier HD, Mercier P, Roche PH. Surgical anatomy of the petrous apex and petroclival region. Adv Tech Stand Neurosurg. 2007;32:91-146.
Quesada J, Kong A, Tweddle E. An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings. Radiol Case Rep. 2021;16(12):3903-3907.
Suzich KL, Adelson S, Choi CS. An Interesting Case of Gradenigo Syndrome. J Binocul Vis Ocul Motil. 2019;69(1):1-2.
Bano S, Nawaz A, Asmar A, Aemaz Ur Rehman M, Farooq H, Ali H. Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature. eNeurologicalSci. 2022;27:100397.
Lee DH, Kim MJ, Lee S, Choi H. Anatomical Factors Influencing Pneumatization of the Petrous Apex. Clin Exp Otorhinolaryngol. 2015;8(4):339-44.
Protasova IN, Per'yanova OV, Podgrushnaya TS. Acute otitis media in the children: etiology and the problems of antibacterial therapy. Vestn Otorinolaringol. 2017;82(2):84-89.
Giannakopoulos P, Chrysovergis A, Xirogianni A, Nikolopoulos TP, Radiotis A, Lebessi E, et al. Microbiology of acute mastoiditis and complicated or refractory acute otitis media among hospitalized children in the postvaccination era. Pediatr Infect Dis J. 2014;33(1):111-113.
Favier M, Bessou P, Franco-Vidal V, Pédespan JM. Gradenigo syndrome and petrositis in a child. Arch Pediatr. 2015;22(3):283-286.
Jacobsen CL, Bruhn MA, Yavarian Y, Gaihede ML. Mastoiditis and Gradenigo's Syndrome with anaerobic bacteria. BMC Ear Nose Throat Disord. 2012;12(10).
Potter GM, Siripurapu R. Imaging of Petrous Apex Lesions. Neuroimaging Clin N Am. 2021;31(4):523-540.
Gore MR. Gradenigo’s Syndrome: A Review. Ann Med Health Sci Res. 2018;8(4):220-224.
Chan KC, Chen SL. Diplopia in a Child: Gradenigo Syndrome Is an Unforgettable Disease. Ear Nose Throat J. 2023;102(2):53-55.
Gadre AK, Chole RA. The changing face of petrous apicitis-a 40-year experience. Laryngoscope. 2018;128(1):195-201.
Sousa A, Ribeiro D, Balona F, Maré R, Azevedo C, Rocha J, et al. Gradenigo's Syndrome with Carotid Septic Stenosis. Case Rep Otolaryngol. 2020; 2020:9439184.
Janjua N, Bajalan M, Potter S, Whitney A, Sipaul F. Multidisciplinary care of a paediatric patient with Gradenigo's syndrome. BMJ Case Rep. 2016; 2016:bcr2015214337
Branco T, Marques C, Santos VC, Lopes JM. Gradenigo's Syndrome With Septic Lateral Sinus Thrombosis. Cureus. 2023;15(2):e34797.
Isaac H, Liu A, Shibata SB, Hansen MR. Transmastoid and Transtemporal Drainage of Petrous Apicitis with Otitis Media. Ann Otol Rhinol Laryngol. 2021;130(3):314-318.
Li KL, Agarwal V, Moskowitz HS, Abuzeid WM. Surgical approaches to the petrous apex. World J Otorhinolaryngol Head Neck Surg. 2020;6(2):106-114.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Médicas UIS