extend through air cells to the petrous portion of the temporal bone, causing a constellation of symptoms of diplopia (sixth cranial nerve palsy), severe ocular pain, and otorrhea; this trifecta is known as Gradenigo syndrome) The infection may extend through the mastoid tip into the upper neck, and create a Bezold abscess The most common intracranial problem associated with AOM is meningitis, often associated with severe sensorineural deafness and irreversible vestibular damage Less commonly associated problems include cerebritis, epidural abscess, brain abscess, lateral sinus thrombosis, and otitic hydrocephalus The child with overt or impending intracranial complications should be stabilized, given IV antibiotics, and evaluated with a CT scan with contrast or magnetic resonance imaging (MRI) scan SINUSITIS Goals of Treatment The common cold and upper respiratory tract infection account for the majority of infections of the nose and paranasal sinuses However, bacterial infection of the sinuses is a more serious condition that requires careful examination and prompt treatment Differentiating bacterial from viral infections can be difficult but is an important aspect of treatment Severe complications can also result from untreated acute bacterial rhinosinusitis (ABR), including orbital cellulitis, intracranial abscess, and meningitis Preventing these life-threatening complications as well as prompt recognition and treatment when they occur are important goals of treatment CLINICAL PEARLS AND PITFALLS Imaging studies are not indicated for uncomplicated acute bacterial sinusitis Persistence of symptoms longer than 10 days can help differentiate between bacterial sinusitis and viral upper respiratory infection Amoxicillin-clavulanate is an appropriate first-line choice for oral antibiotic therapy in acute bacterial sinusitis Current Evidence Between 5% and 7% of viral upper respiratory infections are complicated by the development of secondary bacterial rhinosinusitis ABR should be suspected