A 22-year-old man with long-standing left-sided foul-smelling ear discharge develops diplopia on looking towards the left and severe pain over the left temple and orbit. Examination reveals ipsilateral lateral rectus palsy. Which complication of chronic otitis media best explains this presentation?

• A Extradural abscess of the middle cranial fossa
• B Inflammation of the geniculate ganglion
• C Cerebellar abscess compressing the sixth nerve nucleus
• D Apical petrositis producing Gradenigo's syndrome ✓

Explanation

Gradenigo's syndrome is the classic triad of persistent otorrhoea, pain in the distribution of the ophthalmic division of the trigeminal nerve, and ipsilateral sixth nerve palsy with diplopia. It results from extension of infection to the petrous apex, which lies close to Meckel's cave and Dorello's canal carrying the abducens nerve. An extradural abscess causes headache and meningism but not a specific ocular motor palsy, which is the discriminating finding here.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.