Gradenigo’s syndrome: a petrous apex lesion
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20201049Keywords:
Canal wall down tympano-mastoidectomy, Gradenigo’s syndrome, Pseudomonas, Unsafe chronic suppurative otitis mediaAbstract
Unsafe chronic suppurative otitis media (CSOM) requires early attention, otherwise leads to various extracranial and intracranial complications. Petrositis is one of the complications of temporal bone due to unsafe CSOM leading to inflammation or abscess in the petrous apex along with involvement cranial nerves V and VI nerve and leading to a trio of symptoms like ipsilateral otorrhea, deep facial pain and ipsilateral lateral rectus palsy, this clinical trio collectively called as Gradenigo’s syndrome. We have done retrospective study of 3 cases who were presented to our tertiary care centre ENT-OPD with symptoms suggestive of Gradenigo’s syndrome. Cases selected by simple random sampling. Cases with ear malignancy was excluded from study. Cases were followed up for 3 months and results were analysed. Petrositis if ignored can lead to rare but fatal complication of unsafe CSOM. Common in males in third decade and the ear swab suggestive of common organism was pseudomonas. Medical management given as per culture and sensitivity report of ear swab and then followed by definitive surgery of canal wall down tympano-mastoidectomy with petrous apex decompression.
References
Gibier L, Darrouzet V, Franco-Vidal V. Gradenigo syndrome without acute otitis media. Pediatr Neurol. 2009;41(3):215-9.
Tornabene S, Vilke GM. Gradenigo's syndrome. J Emerg Med. 2010;38(4):449-51.
Lutter SA, Kerschner JE, Chusid MJ. Gradenigo syndrome: a rare but serious complication of otitis media. Pediatr Emerg Care. 2005;21(6):384-6.
Plodpai Y, Hirunpat S, Kiddee W. Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report. J Med Case Rep. 2014;8:217.
Kantas I, Papadopoulou A, Balatsouras DG, Aspris A, Marangos N. Therapeutic approach to Gradenigo's syndrome: a case report. J Med Case Rep. 2010.
Matis GK, de A Silva DO, Chrysou OI, Karanikas MA, Birbilis TA. Giuseppe Gradenigo: Much more than a syndrome! Historical vignette. Surg Neurol Int. 2012;3:122.
Hafidh MA, Keogh I, Walsh RM, Walsh M, Rawluk D. Otogenic intracranial complications. a 7-year retrospective review. Am J Otolaryngol. 2006;27(6):390-5.
Hardjasudarma M, Edwards RL, GanleyJP, Aarstad RF. Magnetic resonance imaging features of Gradenigo’s syndrome. Am J Otolaryngol. 1995;16:247-50.
Hitier M, Boutet C, Faure C,Moreau S. Radiology quiz case 2. Gradenigo’s syndrome caused by right petrous apicitis. Arch Otolaryngol Head Neck Surg. 1998;119:444-54.
Rossor TE, Anderson YC, Steventon NB, Voss LM. Conservative management of Gradenigo's syndrome in a child. BMJ Case Rep. 2011;2011:bcr0320113978.
Kandakure VT, Khokle PD, Shah UR. Management of unsafe type of chronic supportive otitis media with extracranial complications of tertiary care center. Indian J Otol. 2018;24:129-34.
Jacobsen CL, Bruhn MA, Yavarian Y, Gaihede ML. Mastoiditis and Gradenigo’s Syndrome with anaerobic bacteria. BMC Ear Nose Throat Disord. 2012;12:10.
