Gradenigo syndrome: a case report and review of a rare complication of otitis media.

Otitis media is a commonly seen condition in the Emergency Department. The complications of otitis media that were seen frequently in the preantibiotic era are now rare today. We report a case of a diabetic man who presented with otorrhea, retro-orbital pain, and diplopia secondary to a sixth cranial nerve palsy--Gradenigo syndrome. This syndrome occurs as infection from the middle ear spreads medially to the petrous portion of the temporal bone. The emergency physician should consider this condition in patients with chronic ear drainage or pain not responsive to conventional treatment or in any patient with a cranial nerve palsy in the setting of acute or chronic otitis. Work-up should include a CT scan of the temporal bones. Otolaryngology consultation and admission for i.v. antibiotics is recommended.