Zengel P, Wiekström M, Jäger L, Matthias C
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München.
HNO. 2007 Mar;55(3):206-10. doi: 10.1007/s00106-006-1399-2.
In 1904 Guiseppe Gradenigo described an infection of the apex of the petrous part of the temporal bone from acute otitis media with the clinical symptoms of unilateral pain around the eye, diplopia due to sixth nerve paralysis and persistant otorrhea. While this infection became evident by inward extension from petrositis in the majority of fatal cases from acute otitis media in the preantibiotic era, it has now become very rare. Today, cases mainly derive from cholesteatomas or chronic osteomyelitis of the petrous bone. However, due to intense antibiotic treatment in acute otitis media clinical signs of petrositis may be less typical compared to former times. We report on a 12-year-old boy with rapid onset of sixth nerve paralysis without clinical signs of acute otitis media or mastoiditis. CT and NMR imaging confirmed infection of the petrous apex. He was treated by mastoidectomy with exploration of a posterior cell group from the epitympanon around the semicircular canals and subsequent high dose intravenous antibiotics. The patient recovered without any loss of inner ear or facial nerve function. The paralysis of the sixth nerve disappeared completely within 6 weeks.
1904年，朱塞佩·格拉代尼戈描述了一种因急性中耳炎导致的颞骨岩部尖端感染，其临床症状为眼周单侧疼痛、因第六神经麻痹引起的复视以及持续性耳漏。在抗生素时代之前，这种感染在大多数由急性中耳炎导致的致命病例中，是通过岩骨炎向内蔓延而显现的，但现在已经非常罕见。如今，病例主要源于胆脂瘤或岩骨慢性骨髓炎。然而，由于急性中耳炎采用了强化抗生素治疗，与过去相比，岩骨炎的临床症状可能不那么典型。我们报告了一名12岁男孩，他迅速出现第六神经麻痹，无急性中耳炎或乳突炎的临床症状。CT和核磁共振成像证实了岩尖感染。他接受了乳突切除术，从鼓室上隐窝围绕半规管探查后组小房，随后静脉注射大剂量抗生素。患者康复，内耳或面神经功能未出现任何丧失。第六神经麻痹在6周内完全消失。
