The triad of symptoms designated as Gradenigo's syndrome is sufficiently classic to be considered a distinct clinical entity. This syndrome was first definitely pointed out by Gradenigo1 in 1904, its three characteristic features being: (1) paralysis of the external rectus muscle supplied by the abducens nerve, (2) unilateral pains in the temporoparietal region on the same side and (3) the presence of an otitis media on the affected side. He described the usual course as follows:
The condition more often occurs in younger patients.
The otitis media is usually, though not always, acute and is commonly accompanied by mastoiditis.
The tympanum may or may not be perforated.
Diplopia sets in suddenly about a month after the onset of symptoms of the middle ear.
Optic neuritis is usually absent. However, when present, it indicates a coincidental infection of the optic nerve.
About two months
FREUND EM. PARALYSIS OF THE ABDUCENS NERVE ACCOMPANYING A CASE OF MASTOIDITIS: AN UNUSUAL FORM OF GRADENIGO'S SYNDROME. Arch Otolaryngol. 1931;13(5):717–725. doi:10.1001/archotol.1931.03660020081007
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