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Gradenigo syndrome is a rare but serious complication of petrous apicitis, characterized by the classic triad of:

1. Otitis media (middle ear infection)
2. Retro-orbital pain (due to trigeminal nerve involvement)
3. Abducens nerve (CN VI) palsy (causing diplopia) </aside>

This triad results from inflammation spreading from the middle ear to involve the petrous apex of the temporal bone.

Etiopathogenesis

• The petrous apex is a part of the temporal bone that may be pneumatized (contains air cells) in some individuals.
• Otitis media or mastoiditis can extend medially into the petrous apex air cells, causing petrous apicitis.

Inflammation in this region affects nearby neurovascular structures:

• Trigeminal nerve (CN V) ganglion in Meckel’s cave → facial pain
• Abducens nerve (CN VI) at Dorello’s canal → lateral rectus palsy → diplopia
• Possible involvement of facial (CN VII) and vestibulocochlear (CN VIII) nerves

Clinical Features

Triad of Gradenigo Syndrome:

1. Persistent otorrhea (from otitis media)
2. Deep facial or retro-orbital pain (V1/V2 distribution)
3. Lateral rectus palsy (diplopia on lateral gaze)

Other possible findings:

• Hearing loss
• Vertigo
• Fever