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petrotitis; petrous apicitis; Gradenigo's syndrome
inflammation of the petrous process of the temporal bone
Etiology:
- otitis media
- suppurative mastoiditis
Pathology:
- inflammation extends from petrous process of the temporal bone which surround the ear into the inner ear
- cranial nerve 5 irritation due to proximity of the Gasserian ganglion in relation to the petrous process
Clinical manifestations:
- otorrhoea
- deep retro-orbital pain, facial pain or headache
- cranial nerve 6 palsy, leading to a lateral rectus palsy
a) inability to look outwards with one eye
b) diplopia
- otalgia, persistent ear discharge
- fever
- confusion, impaired consciousness, coma
- other cranial nerve palsies
a) cranial nerve 5 palsy
b) cranial nerve 7 palsy
c) cranial nerve 9 palsy
Laboratory:
- complete blood count may show leukocytosis
- erythrocyte sedimentation rate &/or serum CRP may be elevated
- culture & sensitivity of otorrhea
Special laboratory:
- biopsy rarely needed
- audiometry
Radiology:
- computed tomography
- magnetic resonance imaging
- SPECT
- bone scan
Management:
1) intravenous antibiotics selected from culture & sensitivity
2) surgical drainage
a) patients who do not respond to antibiotics
b) complications
- cranial nerve palsy
- abscess
- venous sinus thrombosis
General
ear disease
osteomyelitis
syndrome
References
- Petrotitis
University of Tennessee Medical Center
http://www.utmedicalcenter.org/your-health/encyclopedia/disease/001254/
- MedlinePlus: Petrotitis
http://www.nlm.nih.gov/medlineplus/ency/article/001254.htm
- Petrotitis: Patient.co.uk
http://www.patient.co.uk/doctor/Petrositis.htm
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 518