Clinical communication: Adults| Volume 38, ISSUE 4, P449-451, May 2010

Gradenigo's Syndrome

Published:February 27, 2008DOI:


      The syndrome of constant otorrhea, headache, and diplopia, which is attributed to inflammation of the petrous apex, is known as Gradenigo's syndrome. It is often the result of chronic otitis media with long-standing purulent otorrhea. It has traditionally been treated surgically, but recent advances in imaging, allied with improved antibiotic treatment, have allowed for consideration of non-surgical management of these cases. A 60-year-old woman presented to the emergency department with 7 days of right-sided headache, facial pain, and diplopia. She awoke with the headache and facial pain 7 days earlier. She was without any preceding infectious symptoms including ear pain, sinus congestion, sore throat, and cough, and she denied fevers and chills. Examination demonstrated a right eye lateral gaze palsy and reproducible diplopia. Computed tomography studies demonstrated the possibility of fluid in the petrous apex of the temporal bone. A follow-up magnetic resonance imaging study confirmed a moderate amount of fluid in the right petrous apex consistent with Gradenigo's syndrome. Imaging with computed tomography and magnetic resonance is an important tool in the evaluation of petrous apex lesions. Gradenigo's syndrome is a rare condition that does not always present with the classical triad of otorrhea, headache, and diplopia. Appropriate management requires antibiotic treatment and possible surgical intervention.


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        • Gillanders D.A.
        Gradenigo's syndrome revisited.
        J Otolaryngol. 1983; 12: 169-174
        • Sherman S.C.
        • Buchanan A.
        Gradenigo syndrome: a case report and review of a rare complication of otitis media.
        J Emerg Med. 2004; 27: 253-256
        • de Graaf J.
        • Cats H.
        • de Jager A.E.
        Gradenigo's syndrome: a rare complication of otitis media.
        Clin Neurol Neurosurg. 1988; 90: 237-239
        • Chole R.A.
        • Donald P.J.
        Petrous apicitis.
        Ann Otol Rhinol Laryngol. 1983; 92: 544-551
        • Minotti A.M.
        • Kountakis S.E.
        Management of abducens palsy in patients with petrositis.
        Ann Otol Rhinol Laryngol. 1999; 108: 897-902
        • Burston B.J.
        • Pretorius P.M.
        • Ramsden J.D.
        Gradenigo's syndrome: successful conservative treatment in adult and paediatric patients.
        J Laryngol Otol. 2005; 119: 325-329
        • Jackler R.K.
        • Parker D.A.
        Radiographic differential diagnosis of petrous apex lesions.
        Am J Otol. 1992; 13: 561-574
        • Contrucci R.B.
        • Sataloff R.T.
        • Myers D.L.
        Petrous apicitis.
        Ear Nose Throat J. 1985; 64: 54-60