Petrous apicitis: Clinical considerations

Although petrous apicitis was a frequent occurrence in the first half of this century, it has become an uncommon disease because of the widespread use of antibiotics for otitis media. In this series of eight cases of petrous apicitis it is evident that petrositis cannot be equated with Gradenigo's triad (otitis, abducens paralysis, and deep pain) since none of the cases manifested with the classical syndrome. Abducens paralysis was seen in only two of the eight cases. Deep facial or ear pain was present in four of the eight cases and appeared to be the most useful symptom in the diagnosis of petrositis. Four of the eight cases were discovered only after previous, unsuccessful surgical procedures. Chronic petrous apicitis may be occult and manifest only after failure to control suppuration by conventional tympanomastoid surgery. When petrositis is suspected, conventional x-ray study may show bone erosion and asymmetric clouding of the petrous tip. Computed tomographic scanning was most useful in the delineation of bone destruction and opacification of the apex. When the diagnosis of petrous apicitis is made, aggressive surgical drainage is indicated.