Gradenigo’s Syndrome in Postantibiotik Time

Introduction The syndrome described by Giuseppe Gradenigo in 1904 included the triad of abducens paresis, otitis media/mastoiditis with trigeminal pain. It was at a time when there was no antibiotic therapy.

Material and methods In the following poster, a patient with a year-long left-sided headache was initially treated in a neurological clinic. The symptoms were progressive in character. About 12 months after the initial headache, an ipsilateral conductive hearing loss was observed. A month later, the patient presented with left-sided abducens palsy in addition to the listed symptoms.

Results A left-sided wall-up mastoidectomy was performed. Histopathological examination of the left mastoid revealed chronic inflammation. The patient was presented to the rheumatology department and a working diagnosis of granulomatosis with polyangiitis (GPA) was made. The patient is still on low-dose corticosteroids and has been free of recurrence for one year.

Conclusion/Discussion Gradenigo syndrome was first described in the pre-antibiotic era. The triad of Gradenigo affects the tip of the petrous part of the temporal bone. Although the original description is for a bacterial infection, an autoimmune disease with the same symptoms could also occur. Today, in developed countries, acute bacterial infection affecting the primary healthy ear and causing Gradenigo syndrome is extremely rare. Chronic mastoiditis (with/without cholesteatoma), petrous apex tumor, or autoimmune disease are more logical conditions to consider. Interdisciplinary work is crucial here.

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Publication History

Article published online:
12 May 2023