Horner's syndrome as a complication of acute otitis media.

A seventeen-year-old girl presented with acute otitis media, unilateral miosis and ptosis (partial Horner's syndrome) and tenderness of the ipsilateral jugular vein. A culture of the otorrhoea showed Staphylococcus aureus and Streptococcus pyogenes. A CT scan revealed an infiltrate near the ipsilateral carotid artery and jugular vein. The patient was hospitalised and treated with antibiotics. Clinical signs disappeared within 6 days. This report discusses the first case with a partial Horner's syndrome as an unusual complication of acute otitis media (AOM). Imaging studies suggest extracranial lymphatic spread of the infection along the adjacent jugular vein causing pressure on the postsynaptic sympathetic fibres. Recognition of the Horner's syndrome is of importance because it may be an early sign of an extracranial complication of AOM.