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H70.2 Petrositis – Petrous Bone Inflammation
H70.2 is the ICD-10 code for petrositis, an inflammation of the petrous part of the temporal bone. It most commonly develops as a complication of otitis media.
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H70.2 is the ICD-10 code for petrositis, an inflammation of the petrous part of the temporal bone. It most commonly develops as a complication of otitis media.
What is Petrositis (H70.2)?
Petrositis (ICD-10: H70.2) is an inflammation of the petrous bone (Latin: Os petrosum), a dense portion of the temporal bone located at the base of the skull. This bony structure houses critical components of the hearing and balance system. Petrositis is a rare but potentially life-threatening condition that requires prompt medical attention.
Causes
Petrositis most commonly arises as a complication of untreated or inadequately treated otitis media (middle ear infection) or mastoiditis (inflammation of the mastoid process). Bacteria from the middle ear can spread into the petrous bone, causing infection and inflammation.
- Common causative organisms: Streptococcus pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus
- Contributing factors: impaired drainage of the middle ear, anatomical variations, immunodeficiency
- Less commonly: spread from chronic ear infections
Symptoms
The classic clinical presentation of petrositis is known as Gradenigo syndrome, which consists of three hallmark features:
- Ear pain and ear discharge (otorrhoea) due to the underlying ear infection
- Diplopia (double vision) caused by palsy of the sixth cranial nerve (abducens nerve), leading to squinting
- Facial or periorbital pain due to irritation of the fifth cranial nerve (trigeminal nerve)
Additional symptoms may include: fever, headache, dizziness, hearing loss, and neck stiffness as a sign of meningeal involvement.
Diagnosis
Diagnosis is established through clinical examination and imaging:
- Otoscopy: assessment of the eardrum and ear canal
- CT scan of the temporal bone: detection of bone destruction, fluid collections, or abscesses
- MRI (Magnetic Resonance Imaging): evaluation of soft tissue involvement and intracranial complications
- Blood tests: inflammatory markers (CRP, white blood cell count), blood cultures to identify the causative organism
- Lumbar puncture if meningitis is suspected
Treatment
Petrositis typically requires hospital admission and a combination of medical and potentially surgical treatment:
- High-dose intravenous antibiotic therapy: targeted treatment based on culture results, often involving combination antibiotic regimens
- Surgical intervention: drainage procedures or mastoidectomy may be required in cases of abscess formation or failure to respond to antibiotics
- Management of complications: cranial nerve palsies, meningitis, or brain abscess may require intensive care and specialist management
Without prompt treatment, petrositis can lead to serious complications including meningitis, brain abscess, sinus thrombosis, and permanent cranial nerve damage.
Prognosis
When diagnosed early and treated promptly, the prognosis of petrositis is generally favourable. Delayed treatment can result in lasting complications such as permanent cranial nerve palsy or hearing loss. Regular follow-up after recovery is recommended.
References
- World Health Organization – ICD-10 International Classification of Diseases, 10th Revision: H70.2 Petrositis. WHO, Geneva.
- Probst R., Grevers G., Iro H. – Basic Otorhinolaryngology: A Step-by-Step Learning Guide. Thieme, Stuttgart 2006.
- Kangsanarak J., Fooanant S., Ruckphaopunt K., Navacharoen N., Teotrakul S. – Extracranial and intracranial complications of suppurative otitis media. Report of 102 cases. J Laryngol Otol. 1993; 107(11): 999–1004.
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