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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Petrositis is still a very real complication of otitis media. The most striking diagnostic feature is facial and/or retrobulbar pain, and it is the most consistent symptom. External rectus paralysis was present in only one of the four cases presented in this series. Treatment is surgical. In order to spare the cochlea and give adequate exposure to the apical cells, the middle fossa approach to the petrous apex is presented, to be used alone or in conjunction with mastoidectomy.
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PMID:The middle cranial fossa approach to the petrous apex. 93 55

Complications arising from otitis media are rare. However, it is still important to be aware of the potential complications of the infection. Two patients with petrositis who developed Gradenigo's triad (otitis, abducens paralysis and pain) are presented.
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PMID:[Otitis media, petrositis and Gradenigo's syndrome]. 274 Nov 62

Although petrous apicitis was a frequent occurrence in the first half of this century, it has become an uncommon disease because of the widespread use of antibiotics for otitis media. In this series of eight cases of petrous apicitis it is evident that petrositis cannot be equated with Gradenigo's triad (otitis, abducens paralysis, and deep pain) since none of the cases manifested with the classical syndrome. Abducens paralysis was seen in only two of the eight cases. Deep facial or ear pain was present in four of the eight cases and appeared to be the most useful symptom in the diagnosis of petrositis. Four of the eight cases were discovered only after previous, unsuccessful surgical procedures. Chronic petrous apicitis may be occult and manifest only after failure to control suppuration by conventional tympanomastoid surgery. When petrositis is suspected, conventional x-ray study may show bone erosion and asymmetric clouding of the petrous tip. Computed tomographic scanning was most useful in the delineation of bone destruction and of the apex. When the diagnosis of petrous apicitis is made, aggressive surgical drainage is indicated.
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PMID:Petrous apicitis. Clinical considerations. 666 Jul 45

We report a case of sixth nerve palsy as a rare complication of acute otitis media (apical petrositis). The clinical triad of acute otitis media, pain in the distribution of the fifth cranial nerve and sixth nerve palsy is known as Gradenigo syndrome.
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PMID:Gradenigo syndrome: a case-report. 1475 Feb 30

In 1904 Guiseppe Gradenigo described an infection of the apex of the petrous part of the temporal bone from acute otitis media with the clinical symptoms of unilateral pain around the eye, diplopia due to sixth nerve paralysis and persistant otorrhea. While this infection became evident by inward extension from petrositis in the majority of fatal cases from acute otitis media in the preantibiotic era, it has now become very rare. Today, cases mainly derive from cholesteatomas or chronic osteomyelitis of the petrous bone. However, due to intense antibiotic treatment in acute otitis media clinical signs of petrositis may be less typical compared to former times. We report on a 12-year-old boy with rapid onset of sixth nerve paralysis without clinical signs of acute otitis media or mastoiditis. CT and NMR imaging confirmed infection of the petrous apex. He was treated by mastoidectomy with exploration of a posterior cell group from the epitympanon around the semicircular canals and subsequent high dose intravenous antibiotics. The patient recovered without any loss of inner ear or facial nerve function. The paralysis of the sixth nerve disappeared completely within 6 weeks.
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PMID:[Isolated apical petrositis: an atypical case of Gradenigo's syndrome]. 1662 71

Acute otitis media is the most common bacterial infection in children. Despite efficient antibiotic therapy, there are still reports of both intratemporal and intracranial complications with potential risk of high morbidity and mortality. Mastoiditis, apical petrositis and labyrinthitis are caused by the extension of purulent middle ear infection into nearby structures. Giuseppe Gradenigo first described the clinical triad of acute otitis media, unilateral pain in the region innervated by the 1 masculine and 2 masculine branches of the trigeminal nerve and ipsilateral abducens nerve paralysis. This is a serious but rare complication of middle ear infection that should be suspected in every patient with unilateral headache and abducens nerve palsy. We report a case of Gradenigo's syndrome in a 6-year-old boy.
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PMID:[Gradenigo's syndrome: a case-report]. 2054 25

Petrositis is a rare and severe complication of acute otitis media and mastoiditis. Although the extension of the inflammatory process from the petrous apex to the adjacent Meckel cave can lead to trigeminal pain, an irritation of the trigeminal nerve roots resulting in acute or chronic hyperactivity of masticatory muscles has never been reported. We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis. This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs.
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PMID:Unusual fatal petrositis presenting as myofascial pain and dysfunction of the temporal muscle. 2151 62

Gradenigo syndrome is caused by petrous inflammation, also called petrositis. It includes acute otitis media, diplopia, and homolateral retroorbital pain due to trigeminal and abducens nerve injury. We describe a child with petrositis secondary to acute otitis media. The lack of otoscopic abnormality and the presence of bilateral headache made the diagnostic difficult. After complementary investigations searching for an intracranial process, the diagnosis was made based on brain and skull base dimensional computed tomography.
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PMID:[Gradenigo syndrome and petrositis in a child]. 2552 89

Gradenigo-Lannois syndrome or petrous apicitis is an uncommon but a morbid complication of otitis media. Traditionally treated by surgery, recent advances in imaging and antibiotics have favoured a more conservative approach. Although pyogenic organisms are the leading aetiological agent, petrous apicitis due to Koch's bacilli is not rare. We report two cases of tubercular petrositis presenting as Gradenigo's syndrome with triad of ear discharge, deep-seated retro-orbital pain and diplopia. The first patient represented a mixed infection with pyogenic organism and tuberculosis, which was successfully treated with antibiotics and antitubercular therapy. The second patient showed an acute presentation of Gradenigo's syndrome with chronic otitis media having contact with an active tuberculosis case and showed dramatic response with antitubercular treatment. Tubercular petrous apicitis must be suspected and diagnosed promptly as only specific treatment will lead to symptomatic resolution and avoid complications.
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PMID:Unusual manifestation of Koch's disease: Gradenigo-Lannois syndrome. 3313 63