Gradenigo’s Syndrome and Labyrinthitis: Conservative versus Surgical Treatment

Abstract

Background Extracranial intratemporal complications of chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo's syndrome is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. Case Report A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. Conclusion Although there is little evidence to support the use of conservative treatment in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome.

Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo’s Syndrome: Early Dysphagia and Late Abducens Nerve Palsy

“…An elderly patient's peculiarity [5,14,[39][40][41] is the presence of neurological defect, usually diplopia that correlates with Dorello's canal involvement developing in the early stages. Coexistence of predisposing conditions includes diseases like diabetes mellitus [29,37] and immunodeficiency [11].…”

Tinnitus Associated with Mild Osteomyelitis of the Temporal Bone Reversed after Conservative Antibiotic Treatment: A Case Series

“…This included soft tissue density in the middle ear cavity and opacification and bony sequestration was attributed to mucosa thickening of the mastoid air cells (along with the cortical bone) [7]. Although the association between osteomyelitis of the temporal bone and tinnitus remains unclear, previous reports found that tinnitus might be associated with tumor invasion [9] or inflammation [10] of the temporal bone. In the present cases, testing for the potential origins of tinnitus revealed insignificant findings.…”

Case Report: Suppurative Labyrinthitis Induced by Chronic Suppurative Otitis Media

“…Imaging tests are important tools to better understand pathological features and play an important role in diagnosis. Previous research has shown gadolinium in MRI is essential to detect inner ear inflammatory lesions and the temporal bone CT scans can identify lesion extent and location ( 11 , 12 ). In our case, we found fistulae in both the basal turn of the cochlea and the horizontal semicircular canal through the temporal bone CT scans.…”