Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría / Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics

Resumen. La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.

Abstract. Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.

Síndrome de Gradenigo: una complicación poco frecuente de la otitis media aguda / Gradenigo syndrome: a rare complication of acute otitis media

El síndrome de Gradenigo consiste en una tríada clínica dada por otitis media aguda, parálisis unilateral del VI par craneano y dolor retroorbitario ipsilateral. Se atribuye a una petrositis apical aguda, complicación evolutiva de una infección del oído medio. La disponibilidad, el acceso y el uso adecuado de la terapia antibiótica han contribuido a una disminución de la frecuencia de estas complicaciones intratemporales o intracraneales de elevado riesgo de morbimortalidad. El tratamiento de la petrositis aguda ha evolucionado, desde la cirugía radical en la era preantibiótica, al tratamiento médico y cirugía menor combinados, en los últimos años. La oftalmoplejia externa plantea diagnósticos diferenciales con otras entidades clínicas: traumatismos, neoplasias, hipertensión endocraneana y procesos infecciosos intracraneales, como trombosis del seno venoso lateral, abscesos intracraneales epi y subdurales. En esta comunicación se jerarquiza el reconocimiento oportuno de las manifestaciones clínicas de esta complicación poco frecuente con el objetivo de sensibilizar a los profesionales para su abordaje diagnóstico y terapéutico oportuno y adecuado.

The Gradenigo syndrome consists in a clinical triad of acute otitis media, unilateral paralysis of the VI cranial nerve and ipsilateral retroorbital pain. It is attributed to an acute apical petrositis by evolutionary complication from an infection of the middle ear. The availability, the access and adequate use of antibiotic therapy have contributed to decrease the frequency of this intratemporal or intracranial complications with high risk of morbidity and mortality. The treatment of acute petrositis has evolved from radical surgery in the pre-antibiotic era, to medical treatment and minor surgery combined, in recent years. The external ophthalmoplegia raises differential diagnosis with other clinical entities: trauma, neoplasms, endocranial hypertension and intracranial infections like venus thrombosis of the lateral sinus, epi and subdural abscesses. In this communication we rank the early recognition of the clinical manifestations of this rare complication to sensitize the professionals for its diagnostic and therapeutic approach timely and adequate.

Aspectos tomográficos da órbita aguda infecciosa: revisão de literatura / Tomographic findings of acute infections of the orbit: literature review

As doenças que acometem a órbita de forma aguda e não traumática por vezes não são conhecidas por médicos em centros de emergência. Essas condições são decorrentes de diversos fatores, como desordens imunológicas, congênitas, infecciosas, vasculares, entre outras. As causas infecciosas correspondem a mais de 50% de todos os casos e requer rápido diagnóstico e conduta para minimização de sequelas. A tomografia computadorizada (TC) é o exame de imagem de primeira linha nesses casos, sendo geralmente disponível nos centros de emergência e capaz de fornecer auxílio diagnóstico de forma rápida, precisa e eficaz. Esse artigo de revisão visa descrever os principais aspectos tomográficos da órbita aguda infecciosa, correlacionando-os com os dados da literatura.

The acute and nontraumatic diseases that involve the orbit are often little known by most physicians. These conditions are due to several factors, such as immune disorders, congenital, infections, vascular, among others disorders. The infectious causes correspond to more than 50% of all cases and require rapid diagnosis and management in order to minimize sequels. Computed tomography (CT) is the first line imaging method on these cases, generally being available in emergency centers and capable to provide an accurate, quick and effective diagnostic information. This review article aims to describe the main tomographic findings in acute orbit infections, correlating them with the literature data.

Petrositis With Bilateral Abducens Nerve Palsies complicated by Acute Otitis Media

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.

Gradenigo's Syndrome Complicated by Brain Abscess and Lateral Sinus Thrombosis due to Otitis Media

No abstract available.

Gradenigo's Syndrome Complicated by Brain Abscess and Lateral Sinus Thrombosis due to Otitis Media

No abstract available.

Petrositis due to acute otitis media: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

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.

A Case of Petrositis with Abducens Palsy / 대한이비인후과학회지

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.

Management of Otitis Media in Children

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.

A Case of Cavernous Sinus Thrombophlebitis and Abducence Nerve Palsy Secondary to Petrositis / 대한이비인후과학회지

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.

A Case of Tuberculous Petrositis / 대한이비인후과학회지

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.