Gradenigo’s syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report

Abstract

IntroductionGradenigo’s syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. We present a case highlighting the pathological mechanism of this disease, demonstrate rare radiological findings associated with this patient, and showcase successful medical treatment without surgical intervention.Case presentationA 63-year-old Thai man presented with complete Gradenigo triad as a complication of chronic otomastoiditis in spite of clinical history of previous radical mastoidectomy and a nonpneumatization of the petrous apex. Magnetic resonance imaging showed abnormal prominent enhancement at the roof of his right temporal bone, and the dura overlying the floor of right middle cranial fossa and right cavernous sinus. Magnetic resonance imaging also detected right petrous apicitis. With the use of intravenous antibiotics and topical antibiotic eardrops, recovery was observed within 5 days with complete resolution within 2 months.ConclusionsAlthough there is little evidence to support the use of medical therapy in the treatment of Gradenigo’s syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo’s syndrome following chronic otitis media in a patient who underwent previous radical mastoidectomy.

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

“…[3][4][5] Here, we highlighted a case of petrous apicitis presenting as chronic migraine without aura, based on ICHD-3 diagnostic criteria. In reality, presentations of petrous apicitis can vary greatly.…”

“…[3][4][5] Here, we highlighted a case of petrous apicitis presenting as chronic migraine without aura, based on ICHD-3 diagnostic criteria. 5 Finally, Tornabene et al presented a case of a 60-year-old woman with right-sided frontal headaches, facial pain, and diplopia for 7 days who was found to have petrous apicitis. It is important to note that the location of the headache in the right temporal region coincides with the location of the peripheral pathology -inflammation and infection of the right petrous apex of the temporal bone.…”

“…4 Plodpai et al described a case of petrous apicitis in a 63-year-old man presenting as right-sided otorrhea with concomitant constant ipsilateral headache in the right frontal and retro-orbital area radiating to the whole head that had been ongoing for 1 month. 5 Finally, Tornabene et al presented a case of a 60-year-old woman with right-sided frontal headaches, facial pain, and diplopia for 7 days who was found to have petrous apicitis. 9 To understand how petrous apicitis can lead to migraine headaches, it is first important to touch upon the pathophysiology of migraines.…”

“…It is a known complication of acute otitis media, as acute otitis media can extend medially into a pneumatized petrous apex. [3][4][5] Some cases can be occult and manifest only after surgical procedures such as tympanomastoid surgery have failed to control suppuration. Due to its rarity, the incidence in adults is largely unknown.…”

“…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.…”