Gradenigo Syndrome: A Case Report

Abstract

A 12-year-old boy who developed Gradenigo syndrome is reported.
He had acute otitis media and was given antibiotics. Since no improvement was observed, he was referred to our hospital. He had a left side headache and diplopia on left lateral gaze. CT and MRI study showed inflammation of the left petrous apex and loss of the pneumatization of mastoid cells. Gradenigo syndrome with acute otitis media, paralysis of abducens nerve and irritation of the trigeminal nerves was diagnosed.
After antibiotics were given, otitis media with petrositis was improved and headache from trigeminal pain was resolved, but abducens paralysis was not improved. Steroid therapy and hyperbaric oxygenation therapy were started, and abducens paralysis was relieved. Gradenigo reported a syndrome which consists of acute otitis media, paralysis of abducens nerve and irritation of the trigeminal nerves in 1904. Gradenigo's syndrome has become rare since the introduction of antibiotics. 21 cases of this syndrome were reported in Japan from 1980 to 2005 and the pathophysiology, diagnosis and therapy of those cases and of our patient are discussed.