1/16. Gradenigo's syndrome.Gradenigo's syndrome, which is characterised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy may give rise to potentially fatal complications. knowledge of the aetiology and appropriate investigations can lead to early diagnosis. A case is reported which illustrates this.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/16. abducens nerve palsy as the sole presenting symptom of petrous apicitis.Petrous apicitis as a potentially fatal complication of suppurative otitis media presents in a variety of forms. Gradenigo's triad of abducens paralysis, deep facial pain due to trigeminal involvement and acute suppurative otitis media rarely occurs. The conflicting symptoms reported in the literature usually result in the delayed recognition of the condition with potentially disastrous consequences. The VIth nerve palsy is considered to be the least reliable sign as it is least often present. We present a case in which it was the sole presenting symptom.- - - - - - - - - - ranking = 2.5keywords = nerve (Clic here for more details about this article) |
3/16. Multiple cranial nerve palsies complicating tympanomastoiditis: case report.otitis media either acute or chronic, is not uncommon in childhood. Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual. A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is presented. A skull X-ray and MRI scan showed sclerotic mastoids. The outcome on antibiotic treatment was good.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
4/16. streptococcus acidominimus infection in a child causing Gradenigo syndrome.Gradenigo syndrome is a rare presentation of acute petrositis. The clinical triad of Gradenigo syndrome consists of acute suppurative otitis media, severe unilateral headache and abducens nerve palsy. We report the first case of Gradenigo syndrome caused by streptococcus acidominimus, a Gram-positive coccus of the streptococcus viridans group, which rarely causes deep-seated infection in humans. CONCLUSION: Gradenigo syndrome may complicate acute otitis media and should be suspected in case of unilateral headache and abducens nerve palsy. Conservative medical treatment without surgery may be considered in some patients.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/16. facial nerve paralysis secondary to chronic otitis media without cholesteatoma.Numerous papers have been written on facial nerve paralysis caused by chronic suppurative otitis media. However the authors found none documenting the results of therapy in a series of patients in whom facial nerve dysfunction was caused by chronic otitis media without cholesteatoma. Thus, there is little factual information available to help select a specific therapeutic plan for such cases. Over the past decade, the senior author has managed five cases (6 ears) of chronic suppurative otitis media without cholesteatoma in which facial paresis (4 ears) or paralysis (2 ears) developed 10 days or less before surgery. The chronic otitis media involved the mastoid and middle ear in five cases; and the mastoid, middle ear, and petrous apex in one case. Modified radical mastoidectomy was performed in four ears, tympanomastoidectomy with facial recess exposure in one ear, and complete mastoidectomy with middle cranial fossa petrous apicectomy in one ear. Five patients had complete recovery of facial nerve function (House grade I), and one patient had 90 percent recovery (House grade II). The results provide support for semi-emergent surgery in the management of chronic suppurative otitis media when facial nerve paralysis supervenes.- - - - - - - - - - ranking = 4keywords = nerve (Clic here for more details about this article) |
6/16. drainage of retro-parapharyngeal abscess: an additional indication for endoscopic sinus surgery.Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy; in advanced stages, surgical drainage is mandatory. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/16. Gradenigo's syndrome: successful conservative treatment in adult and paediatric patients.A triad of retro-ocular pain, discharging ear and abducens nerve palsy, as described by Gradenigo, has been recognized for 150 years. It has traditionally been treated with surgery, but recent advances in imaging, allied with improved antibiotic treatment, allow conservative management of these cases. We present two cases of Gradenigo's syndrome: a 6-year-old child and a 70-year-old man, both without cholesteatoma, who were managed without mastoidectomy. They both had full recovery of abducens nerve function, although this took 6 and 12 weeks, respectively. In order to manage patients with Gradenigo's syndrome safely, accurate diagnostic radiology is essential, and our findings are presented and discussed. With changing medical technology, a review of the diagnostic and treatment options for this rare but serious condition, is timely.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/16. Prolonged diplopia following sinus vein thrombosis mimicking Gradenigo's syndrome.We report about a boy with the symptoms of Gradenigo's syndrome (abducens nerve palsy, acute otitis media, unilateral headache). The MR imaging showed a sinus vein thrombosis instead of the expected petroapicitis. After 2 weeks of conservative therapy with antibiotics and anticoagulation, without any clinical effort the boy underwent a mastoidectomy. headache and otitis media recovered quickly but the diplopia still remained after 25 months.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
9/16. Otitic hydrocephalus: an uncommon complication of a common condition.A 14-year-old girl presented with bilateral sixth nerve palsies and papilledema after a two-week history of ear drainage and progressive right-sided temporal headache. A computed tomography scan of the head was normal, as were plain films of the mastoids. Lumbar puncture revealed a markedly elevated opening pressure with an otherwise normal cerebrospinal fluid examination, and she was given the diagnosis of pseudotumor cerebri. Despite treatment with acetazolamide, prednisone, and repeated lumbar punctures, her symptoms worsened. A magnetic resonance imaging study revealed thrombosis of the right sigmoid sinus, and repeat computed tomography showed evidence of mastoiditis. Definitive therapy consisted of a right mastoidectomy and antimicrobial therapy, to which the patient responded promptly. This case illustrates an unusual sequela of otitis media--termed otitic hydrocephalus--that resulted from obstruction of the sigmoid sinus. Although otitis media is generally a benign illness, clinicians must be alert to suppurative complications, which may evolve insidiously.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
10/16. subarachnoid space: middle ear pathways and recurrent meningitis.Congenital bony abnormalities of the inner ear may result in a communication between the middle ear and the subarachnoid space. patients with this anomaly often present with recurrent meningitis associated with acute otitis media or with middle ear fluid. This article presents three cases of recurrent meningitis with open middle ear--subarachnoid space connections. The first two cases involve a cerebrospinal fluid leak into the middle ear via the oval window, both patients having a Mondini-type of inner ear deformity. The pathway in the third case opened into the middle ear along the horizontal portion of the facial nerve. Computed tomography (CT) scanning with metrizamide and differential density calculations helped to identify the abnormal pathway and to confirm that the leak has been closed postoperatively. Use of the CT scanner in these cases can be helpful in planning the surgical closure and in postoperative follow-up.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
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