No abstract available.
Brain ; Brain Abscess ; Lateral Sinus Thrombosis ; Otitis ; Otitis Media ; Petrositis ; Transverse Sinuses

No abstract available.
Brain ; Brain Abscess ; Lateral Sinus Thrombosis ; Otitis ; Otitis Media ; Petrositis ; Transverse Sinuses

Petrous apicitis is an extension of infection from the mastoid air cell tract into petrous apex. Petrous apicitis, a potentially fatal complication of suppurative otitis media, presents a variety of symptoms. But the classical findings of petrous apicitis, called Gradenigo's syndrome that include abducens nerve palsy, deep facial pain and acute suppurative otitis media, rarely occur. Gradenigo's syndrome can be treated with surgery, but the advent of antibiotics and early imaging study allow conservative treatment in some uncomplicated cases. With the widespread use of antibiotics, petrous apicitis has become an uncommon disease. So most physicians have little clinical experience in their diagnosis and treatment of this disease. We present a case of Gradenigo's syndrome, which was unresponsive to conservative treatment. We provide here details of our experience of treating the patient with surgery without complication.
Abducens Nerve Diseases ; Anti-Bacterial Agents ; Diagnosis ; Facial Pain ; Humans ; Mastoid ; Otitis Media, Suppurative ; Paralysis* ; Petrositis* ; Petrous Bone

Tuberculous petrositis is a very rare disease. It is thought to be developed by a spread of tuberculous infection from the middle ear or pneumatized air cells of mastoid. We report a patient with tuberculous petrositis who complained persistent headache after previous tympanomastoid surgery. The classic symptoms of petrositis (Gradenigo's syndrome) were absent, but the diagnosis of petrositis was made with CT, MRI and Ga-67 citrate scan. Revision surgery including infracochlear drainage of the petrous apex was performed, and the pathologic report revealed a tuberculous infection.
Citric Acid ; Diagnosis ; Drainage ; Ear, Middle ; Headache ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Petrositis* ; Petrous Bone ; Rare Diseases ; Tuberculosis

Septic inflammation and thrombosis of the cavernous sinus was extremely fatal in the preantibiotic era. After the introduction of antibiotics, the incidence of septic cavernous thrombophlebitis has diminished significantly. It is, however, still a serious disease accompanied by a high morbidity and mortality rate. Therefore, a high index of suspicion and aggressive initiation of treatment is of the utmost importance for the prognosis. A case of cavernous sinus thrombophlebitis and abducence nerve palsy which takes place secondary to petrositis was diagnosed by magnetic resonance imaging (MRI), and is presented here. The resolution of septic thrombus and complete recovery of sixth (abducens) nerve palsy was observed with treatment with antibiotics and steroids accompanied by tympanotomy tube placement.
Anti-Bacterial Agents ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Incidence ; Inflammation ; Magnetic Resonance Imaging ; Mortality ; Paralysis* ; Petrositis* ; Prognosis ; Steroids ; Thrombophlebitis ; Thrombosis

OBJECTIVE: To study the clinical features and conservative treatment of petrositis. METHOD: One case of petrositis was reported and literatures were reviewed. Opacificated air cells in CT, and anomalous, discontinuous hypersignal in MRI T1 and T2 provided evidence of infection of the apex of the petrous temporal bone. RESULT: The patient recovered totally after conservative treatment with intravenous antibiotic, glucocorticoid and neurotrophic therapy, and no recurrence occurred in 1 year follow-up. CT rescan showed the clear air cells of the petrous apex 4 months later. CONCLUSION Petrositis can be diagnosed with specific clinical features, the image of CT and MRI. Conservative treatment could be a good choice.
Adolescent ; Female ; Humans ; Magnetic Resonance Imaging ; Otitis Media ; complications ; diagnosis ; Petrositis ; complications ; diagnosis ; therapy ; Tomography, X-Ray Computed

Otitls media is one of the most common diseases during childhood with a peak incidence and prevalence from 6 to 20 months of age. It is the most frequent disease managed with antibiotics in children. The infection typically develops as a result of bacterial contamination through the Eustachian tube in the presence of preexisting inflammation in the middle ear. The optimal method of management remains open to question and is the subject of continuing controversy. Over-diagnosis of the disease and unnecessary prescription of antibiotics for this condition have contributed to the spread of antimicrobial resistance. Thus, the differential diagnosis between acute otitis media and otitis media with effusion is important to determine the management strategy; whether to use antibiotics and which antibiotics to use when necessary. Otitis media may be accompanied by a variable degree of conductive hearing loss. Both infectious and noninfectious complications of otitis media may result in significant morbidity and complications, including acute and chronic mastoiditis, petrositis, and intracranial infection.
Anti-Bacterial Agents ; Child* ; Diagnosis, Differential ; Ear, Middle ; Eustachian Tube ; Hearing Loss, Conductive ; Humans ; Incidence ; Inflammation ; Mastoid ; Mastoiditis ; Otitis Media with Effusion ; Otitis Media* ; Otitis* ; Petrositis ; Prescriptions ; Prevalence

Petrous apicitis is a rare but fatal complication of otitis media. An infection within the middle ear can extend within the temporal bone into the air cells of the petrous apex. With only the thin dura mater separating the trigeminal ganglion and the 6th cranial nerve from the bony petrous apex, they are vulnerable to inflammatory processes, resulting in deep facial pain, lateral rectus muscle paralysis, and diplopia. In 1904, Gradenigo described a triad of symptoms related to petrous apicitis, including acute suppurative otitis media, deep facial pain resulting from trigeminal involvement, and abducens nerve palsy. It has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow conservative management. In this case report, we describe a clinical and neuroradiological evolution of a child with a petrous apicitis after acute otitis media, which was managed medically with a positive outcome.
Abducens Nerve Diseases* ; Abducens Nerve* ; Child ; Cranial Nerves ; Diplopia ; Dura Mater ; Ear, Middle ; Facial Pain ; Humans ; Muscles ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Paralysis ; Petrositis* ; Petrous Bone ; Temporal Bone ; Trigeminal Ganglion