INTRODUCTION: Gradenigo's syndrome is nowadays a rare condition characterized by 
a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens 
nerve palsy. Most cases are caused by medial extension of acute otitis media 
into a pneumatized petrous apex and surgical drainage is usually the treatment 
of choice. We present a case highlighting the pathological mechanism of this 
disease, demonstrate rare radiological findings associated with this patient, 
and showcase successful medical treatment without surgical intervention.
CASE PRESENTATION: A 63-year-old Thai man presented with complete Gradenigo 
triad as a complication of chronic otomastoiditis in spite of clinical history 
of previous radical mastoidectomy and a nonpneumatization of the petrous apex. 
Magnetic resonance imaging showed abnormal prominent enhancement at the roof of 
his right temporal bone, and the dura overlying the floor of right middle 
cranial fossa and right cavernous sinus. Magnetic resonance imaging also 
detected right petrous apicitis. With the use of intravenous antibiotics and 
topical antibiotic eardrops, recovery was observed within 5 days with complete 
resolution within 2 months.
CONCLUSIONS: Although there is little evidence to support the use of medical 
therapy in the treatment of Gradenigo's syndrome resulting from chronic ear 
disease, we here demonstrate successful conservative treatment of Gradenigo's 
syndrome following chronic otitis media in a patient who underwent previous 
radical mastoidectomy.