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Petrous Apicitis: A Systematic Review and Case Presentation
Guy Talmor1, Mayand Vakil, Chris Tseng
1Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Introduction:
Petrous apicitis (PA) is a rare but dangerous complication of acute otitis media. The objective of this study is to present a case of PA and systematically review the existing literature on PA to characterize clinical presentation, diagnosis, management, and outcomes in the antibiotic era.
Methods:
A comprehensive search from 1983 to June 1, 2020, of PubMed, MEDLINE, Cochrane Library, and EmBase databases was conducted. Studies with clinical data regarding patients with PA were included. Non-English literature or studies with insufficient individual patient data were excluded. Sixty-seven studies were included with a total of 134 patients.
Results:
A total of 67 articles were found to meet criteria for inclusion. The mean age of presentation was 33 years. Recent acute otitis media was reported in 78 patients (58.2%). Only 3 patients (2.2%) were immunocompromised, and 8 patients (6.0%) had a history of diabetes. Gradenigo's triad of abducens palsy, otorrhea, and retro-orbital or facial pain was reported in 28 patients (20.9%); however, these presenting symptoms were common individually (51.5%, 48.5%, and 64.2%, respectively). Hearing loss (35.8%), facial weakness (17.9%), and vertigo (7.5%) were also reported.The most frequently cultured pathogen was Pseudomonas (34.2%), followed by Streptococcus and Staphylococcus. All 134 patients underwent imaging, with computed tomography being the most frequently used modality (56.0%). Nearly all patients received antibiotic therapy (95.6%), with 91 (67.9%) undergoing surgery ranging from myringotomy (26.9%) to petrosectomy (25.4%). Five patients (5.7%) died because of complications related to PA. Mean follow-up was 11.0 months.
Conclusions:
Petrous apicitis has a variable presentation with potential for severe morbidity. Mortality rates are low, and presentation with Gradenigo's triad is uncommon. Appropriate medical management with surgical drainage can avoid long-term sequelae.
Insights
Petrous apicitis (PA) is a rare complication of middle ear infections. Early diagnosis and treatment, including antibiotics and surgery, can prevent severe outcomes.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neurosurgery
Background:
- Petrous apicitis (PA) is a rare but serious complication of acute otitis media.
- This study reviews the clinical presentation, diagnosis, management, and outcomes of PA in the antibiotic era.
Observation:
- A systematic review included 67 studies with 134 patients diagnosed with PA.
- The most common preceding condition was acute otitis media (58.2%).
- Gradenigo's triad was uncommon (20.9%), but individual symptoms like retro-orbital pain (64.2%) were frequent.
Findings:
- Pseudomonas was the most common pathogen (34.2%).
- Computed tomography was the primary imaging modality (56.0%).
- Most patients received antibiotics (95.6%), and many underwent surgery (67.9%).
Implications:
- Petrous apicitis presents variably and can lead to severe morbidity.
- Low mortality rates are achievable with prompt medical and surgical management.
- Early intervention can prevent long-term sequelae of petrous apicitis.
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