In the routine practice of ophthalmology when patients present themselves with extra-ocular muscle paralyses which have developed suddenly, one is inclined to be content with inferring probable syphilitic etiology or some toxic cause, in case there is no history of traumatism. This habit of practice has led too often to the neglect of a careful search for a definite underlying cause and a definite pathologic lesion.
There are many conditions that may be responsible for paralysis or paresis of the third, fourth and sixth cranial nerves, and the whole subject is full of interest; but I wish at this time to call attention definitely to paralyses of a single nerve, namely, the abducens, which occur rarely but unmistakably in the course of purulent otitis media.
In 1904, Gradenigo1 described a symptom complex which is now known as Gradenigo's syndrome or triad. It is characterized by (a) acute otitis media
WHEELER JM. PARALYSIS OF THE SIXTH CRANIAL NERVE ASSOCIATED WITH OTITIS MEDIA. JAMA. 1918;71(21):1718–1722. doi:10.1001/jama.1918.02600470016007