Mastoiditis and Gradenigo’s Syndrome with anaerobic bacteria

Abstract

BackgroundGradenigo’s syndrome is a rare disease, which is characterized by the triad of the following conditions: suppurative otitis media, pain in the distribution of the first and the second division of trigeminal nerve, and abducens nerve palsy. The full triad may often not be present, but can develop if the condition is not treated correctly.Case presentationWe report a case of a 3-year-old girl, who presented with fever and left-sided acute otitis media. She developed acute mastoiditis, which was initially treated by intravenous antibiotics, ventilation tube insertion and cortical mastoidectomy. After 6 days the clinical picture was complicated by development of left-sided abducens palsy. MRI-scanning showed osteomyelitis within the petro-mastoid complex, and a hyper intense signal of the adjacent meninges. Microbiological investigations showed Staphylococcus aureus and Fusobacterium necrophorum. She was treated successfully with intravenous broad-spectrum antibiotic therapy with anaerobic coverage. After 8 weeks of follow-up there was no sign of recurrent infection or abducens palsy.ConclusionGradenigo’s syndrome is a rare, but life-threatening complication to middle ear infection. It is most commonly caused by aerobic microorganisms, but anaerobic microorganisms may also be found why anaerobic coverage should be considered when determining the antibiotic treatment.

Rare case of chronic suppurative otitis media with gradenigo syndrome

“…A magnetic resonance venogram may also be performed to rule out comorbid venous sinus thrombosis which may occur as a complication of this entity. 2,[6][7][8] The management of Gradenigo syndrome includes medication, surgical, and conservative approaches.…”

Unusual Case- Revisited- Gradenigo’s Syndrome

“…Still it is a potentially fatal complication secondary to acute otitis media and acute mastoiditis because of intracranial spread of infections. (5) This syndrome is most commonly seen with chronic suppurative otitis media in adult population and in children with acute otitis media. On the contrary our case was an adult, having acute otitis media presented with petrous apicitis.…”

New onset strabismus in association with ear pain

“…The abducens nerve is affected by surrounding inflammation as it passes through Dorello's canal, the anatomical region between petrous apex and petrosphenoidal ligament (figure 2). 3 MRI is the optimal imaging modality—acute petrous apicitis with abscess formation is appreciated as a hyperintense lesion on T2 and low intensity lesion on T1 weighted images that may enhance post gadolinium.Most cases are due to aerobic organisms but anaerobic infections have been reported, warranting anaerobic antibiotic cover 4. Intravenous antibiotics are recommended for at least 2–3 weeks, although patients with an associated osteomyelitis may require up to 6 weeks of medical treatment.…”

“…Most cases are due to aerobic organisms but anaerobic infections have been reported, warranting anaerobic antibiotic cover 4. Intravenous antibiotics are recommended for at least 2–3 weeks, although patients with an associated osteomyelitis may require up to 6 weeks of medical treatment.…”