The Diagnosis, Management, and Outcomes of Gradenigo Syndrome in Children: A Scoping Review of the Literature

Purpose: Gradenigo syndrome is a rare complication of acute otitis media (AOM) in children, characterized by suppurative otitis media, unilateral facial pain, and ipsilateral abducens nerve palsy. This review summarizes pediatric data on the presentation, diagnostics, treatment, and outcomes. Methods: A literature research was conducted using the terms “Gradenigo syndrome,” “petrous apicitis,” and “complications otitis media.” Pediatric cases were analyzed for demographics, symptoms, diagnostic findings, therapeutic strategies, and clinical outcomes. Results: Sixty-three articles described 65 patients (mean age: 8.0 years). The classic triad occurred in 22% of cases; 74% showed incomplete presentations. Imaging revealed petrous apex inflammation (84%) and petrous bone tip obliteration (49%). Antibiotics were administered in 88% of cases, most commonly third-generation cephalosporins. Surgery was performed in 72%, mainly myringotomy, tympanostomy tube insertion, and mastoidectomy; no direct petrous apex approaches were reported. Pathogens were identified in 41% of cases, most commonly Fusobacterium necrophorum. Clinical improvement occurred in 98%, with 75% achieving a complete resolution; complications were reported in 29%, including one fatality (2%). Conclusions: Given its variable presentation, comprehensive diagnostic imaging is essential for the diagnosis of Gradenigo syndrome. Early broad-spectrum antibiotic therapy is essential. Surgical intervention is required in severe cases. Long-term targeted antibiotic therapy may help prevent recurrence.