Clinical and Experimental Otorhinolaryngology  2014;7(1):59-62

Petrositis With Bilateral Abducens Nerve Palsies complicated by Acute Otitis Media.

Kyu Young CHOI 1 ; Su Kyoung PARK

Affiliations

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Keywords

Petrous bone; Otitis media; Abducens nerve palsy

Country

Republic of Korea

Language

English

Abstract

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.