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11.4
Ears A host of conditions affecting the external, middle and inner ear may give rise to headpain which is usually focal, localized to the ear or temporal region. Infection is the most common and is typified by the ear aches so common in children as the result of otitis media. Trauma and tumor are the other most common causes and are well covered in most standard otolaryngology texts. Only a few conditions of particular interest to neuro-ophthamolgists, neurologists and neurosurgeons will be reviewed here. See also Ramsay Hunt Syndrome. and Nervous intermedius neuralgia. Facial Pain with Sixth Nerve Palsy (Gradenigo's Syndrome) A brief report by Gradenigo in 1904 described the simultaneous occurrence of suppurative otitis media and lateral rectus palsy secondary to inflammatory edema at the apex of the petrous pyramid (Figure 36.7). The associated pain is boring or throbbing, becomes worse at night, and is often quite severe. It is aggravated by jaw movement, pressure over the tragus, and traction upon the auricle (Dutton, 1939). It is a deep headache, centered within the ear (Friedman and Merritt, 1959), and may be combined with pain in the frontal and parietal regions. In severe cases, irritation of the trigeminal nerve causes unilateral aching pain in the trigeminal distribution (Spiegel and Sommer, 1944). Most cases of Gradenigo's syndrome were seen prior to 1945 and the era of systemic antibiotics. Children (as well as adults) with early evidence of ear infections are invariably immediately placed on antibiotics, thus reducing the risk of suppuration. |