Gradenigo Syndrome

🧠 Gradenigo’s Syndrome

📌 Definition of Gradenigo’s Syndrome

A rare complication of acute or chronic otitis media characterized by a classical triad due to involvement of cranial nerves near the petrous apex.

🧠 Classical Triad of Gradenigo’s Syndrome

Mnemonic: EAR

• E – Ear discharge
• A – Abducens (VI) nerve palsy
• R – Retro-orbital/facial pain

First described by Giuseppe Gradenigo, 1904.

When should you suspect Gradenigo syndrome?

🔬 Pathophysiology of Gradenigo’s Syndrome

1. Otitis media (acute or chronic) → mastoiditis

2. Spread to petrous apex via:

   • Posterior superior air cell tract
   • Anteroinferior cell tract

3. Involvement of:

   • Trigeminal ganglion → retro-orbital pain
   • Abducens nerve in Dorello’s canal → diplopia

4. Possible intracranial spread → meningitis, venous sinus thrombosis

🦠 Etiology of Gradenigo’s Syndrome

• Complication of acute or chronic otitis media with petrositis

What are the risk factors of Gradenigo's syndrome?

🧪 Investigations of Gradenigo’s Syndrome

1️⃣ MRI Brain

• Petrous apex inflammation
• Cranial nerve enhancement
• Soft tissue changes

2️⃣ CT Temporal Bone

• Bony erosion
• Petrous apex pneumatization
• Mastoid air cell involvement

What is the gold standard investigation in Gradenigo's Syndrome?

💊 Treatment of Gradenigo’s Syndrome

Medical (First-line)

• IV antibiotics 4–6 weeks
• Analgesics
• Steroids (cautiously) for cranial nerve inflammation

Which antibiotic is preferred in Gradenigo's syndrome?

Surgical (if medical fails or complications present)

• Mastoidectomy
• Petrous apex drainage

What are the different surgical approaches to Petrous Apex?

⚠️ Complications of Gradenigo’s Syndrome

• Meningitis
• Brain abscess
• Lateral sinus thrombosis
• Sepsis
• Permanent cranial nerve deficits

📈 Prognosis of Gradenigo’s Syndrome

• Good if diagnosed and treated early
• Cranial nerve deficits often reverse with treatment