A case of Gradenigo syndrome successfully recovered by conservative therapy

DOI
  • Hachisu Takuya
    Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center
  • Tada Takeshi
    Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center
  • Umibe Akiko
    Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center
  • Anazawa Utaro
    Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center
  • Tanaka Yasuhiro
    Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center

Bibliographic Information

Other Title
  • 保存的加療にて治癒が得られたGradenigo症候群の1例

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Abstract

<p>Gradenigo’s syndrome is characterized by otitis media, trigeminal neuralgia, and paralysis of the abducens nerve. Gradenigo first reported this syndrome characterized by acute otitis media, irritation of the trigeminal nerves, and paralysis of the abducens nerve in 1904. Here, we report the case of a 51-year-old man with severe diabetes mellitus who was referred to the local hospital due to left otalgia. The patient was given oral antibiotics after he was diagnosed with acute otitis media. However, the patient did not respond to treatment. Three weeks later, he complained of trigeminal neuralgia and paralysis of the abducens nerve. He was then referred by the local hospital to our hospital. Computed tomography revealed right mastoiditis and no intradural or brain lesion. There was no evidence of petrous apicitis. However, magnetic resonance imaging revealed a lesion in the left petrous apex that had low density on T1-weighted images, high density on T2-weighted images, and high density on diffusion-weighted images. The patient was diagnosed with Gradenigo syndrome’s, for which he underwent ventilation tube insertion during hospitalization. He was started on intravenous ceftriaxone at 4 g/day, combined with hydrocortisone at 1 g/day to improve dura edema. The patient responded to conservative treatment with broad-spectrum antibiotics and intensive insulin therapy. Therefore, surgery was not performed. After treatment, otorrhea and temporal pain quickly diminished. Paralysis of the abducens nerve resolved completely after 3 months. He was discharged on day 10 of hospitalization. He has been attending our out-patient clinic for regular check-ups for 6 months, with no apparent symptoms.</p>

Journal

  • Otology Japan

    Otology Japan 27 (5), 699-705, 2017

    Japan Otological Society

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