PDF(Pubmed)
Abstract：
BACKGROUND With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more uncommon is Gradenigo syndrome (GS), a result of PA, characterized by a triad of otitis media or purulent otorrhea, pain within the regions innervated by the first and second division of the trigeminal nerve, and ipsilateral abducens nerve palsy. Recent literature has demonstrated increasing reports of Fusobacterium necrophorum isolated in cases of GS. CASE REPORT A 21-year-old man presented with otalgia, reduced hearing, and severe headache. Examination revealed right-sided purulent otorrhea, anesthesia within the trigeminal nerve distribution, and an ipsilateral abducens nerve palsy. F. necrophorum was isolated from an ear swab and a blood culture. Computed tomography and magnetic resonance imaging (MRI) demonstrated otomastoiditis, PA, cavernous sinus thrombosis, and severe stenosis of the petrous internal carotid artery. He was treated with intravenous benzylpenicillin, underwent a mastoidectomy and insertion of a ventilation tube, and was started on a 3-month course of dabigatran. Interval MRI showed improved internal carotid artery caliber, persistent petrous apex inflammation, and normal appearance of both cavernous sinuses. Follow-up clinical review noted persistent abducens and trigeminal nerve dysfunction. CONCLUSIONS We identified 190 cases of PA; of these, 80 presented with the classic Gradenigo triad. Fusobacterium sp. were cultured in 10% of GS cases, making them the most frequent isolates. Due to the fastidious nature of F. necrophorum, it may be underrepresented in the historical literature, and we recommend that empiric antibiotics cover anaerobic organisms.
摘要：
背景技术随着抗生素的出现,岩性耳炎（PA），颞骨骨质发炎，已成为中耳炎的罕见并发症。更不常见的是Gradenigo综合征（GS），PA的结果，以中耳炎或化脓性耳漏三联征为特征，由三叉神经的第一和第二部分支配的区域内的疼痛，和同侧外展神经麻痹。最近的文献表明，在GS病例中分离出的坏死梭杆菌的报道越来越多。病例报告一名21岁男子出现耳痛，听力降低,和严重的头痛。检查显示右侧化脓性耳漏，三叉神经内的麻醉分布，和同侧外展神经麻痹。从耳拭子和血液培养物中分离坏死F.。计算机断层扫描和磁共振成像（MRI）显示出耳乳突炎，PA,海绵窦血栓形成,颈内动脉岩性严重狭窄。他接受了静脉注射苄青霉素治疗，接受了乳突切除术并插入了通风管，并开始了为期3个月的达比加群课程。间期MRI显示颈内动脉口径改善，持续性岩尖炎症，和两个海绵状窦的正常外观。随访临床回顾发现持续性外展和三叉神经功能障碍。结论我们确定了190例PA；其中，80与经典的Gradenigo三合会一起呈现。梭杆菌属。在10%的GS病例中培养，使它们成为最常见的隔离物。由于死角的挑剔性质，它在历史文献中可能代表性不足，我们建议经验性抗生素覆盖厌氧生物。
