Case report

BMC Ear, Nose and Throat Disorders

, 12:10

Open Access This content is freely available online to anyone, anywhere at any time.

Mastoiditis and Gradenigo’s Syndrome with anaerobic bacteria

  • Chris Ladefoged JacobsenAffiliated withDepartment of Otolaryngology, Head and Neck Surgery, Aalborg Hospital - Aarhus University Hospital Email author 
  • , Mikkel Attermann BruhnAffiliated withDepartment of Otolaryngology, Head and Neck Surgery, Aalborg Hospital - Aarhus University Hospital
  • , Yousef YavarianAffiliated withDepartment of Radiology, Aalborg Hospital - Aarhus University Hospital
  • , Michael L GaihedeAffiliated withDepartment of Otolaryngology, Head and Neck Surgery, Aalborg Hospital - Aarhus University Hospital

Abstract

Background

Gradenigo’s syndrome is a rare disease, which is characterized by the triad of the following conditions: suppurative otitis media, pain in the distribution of the first and the second division of trigeminal nerve, and abducens nerve palsy. The full triad may often not be present, but can develop if the condition is not treated correctly.

Case presentation

We report a case of a 3-year-old girl, who presented with fever and left-sided acute otitis media. She developed acute mastoiditis, which was initially treated by intravenous antibiotics, ventilation tube insertion and cortical mastoidectomy. After 6 days the clinical picture was complicated by development of left-sided abducens palsy. MRI-scanning showed osteomyelitis within the petro-mastoid complex, and a hyper intense signal of the adjacent meninges. Microbiological investigations showed Staphylococcus aureus and Fusobacterium necrophorum. She was treated successfully with intravenous broad-spectrum antibiotic therapy with anaerobic coverage. After 8 weeks of follow-up there was no sign of recurrent infection or abducens palsy.

Conclusion

Gradenigo’s syndrome is a rare, but life-threatening complication to middle ear infection. It is most commonly caused by aerobic microorganisms, but anaerobic microorganisms may also be found why anaerobic coverage should be considered when determining the antibiotic treatment.

Keywords

Gradenigo’s syndrome Acute mastoiditis Apical petrositis Acute otitis media Abducens palsy Fusobacterium necrophorum