title: The changing face of petrous apicitis-a 40-year experience.
abstract: Petrous apicitis (PA) is a rare complication of otitis media. Gradenigo syndrome, with the classic triad of otitis, deep pain, and abducens paralysis, is rarer still. The objective of this study was to determine if clinical presentation and management has changed over time.
  
  
  
  Retrospective chart review.
  
  
  
  Forty-four patients with PA over a 40-year period were studied. Symptoms, signs, and management outcomes were studied. Historical review, surgical anatomy and approaches, pathology, and microbiology, and an illustrative case are included as appendices.
  
  
  
  The classical Gradenigo triad of retro-orbital pain, otitis, and abducens palsy occurred in only six of 44 patients (13.6%). Over the 40-year observation period, those needing surgery has decreased.
  
  
  
  Antibiotics remain the primary treatment modality. Surgery is reserved for cases failing to respond to antibiotics. One of the 44 patients in this series died of his disease. Diagnosis and management algorithms based on these observations are suggested.
  
  
  
  4. Laryngoscope, 128:195-201, 2018.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Heuser Hearing Institute, University of Louisville, Louisville, Kentucky, U.S.A.|Department of Surgery, Heuser Hearing Institute, University of Louisville, Louisville, Kentucky, U.S.A.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gadre
authors.affiliation: Department of Otolaryngology, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Chole
mesh_terms: D020434:Abducens Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003952:Diagnostic Imaging; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000150:complications*; D010147:Pain Measurement; D059270:Petrositis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gradenigo's syndrome; Petrous apicitis; abducens nerve; complications of otitis media; facial pain; lateral rectus palsy; otorrhea; petrositis; petrous apex; retro-orbital pain