A 3-year-10-month-old girl presented to the Emergency Department with persistent right-sided facial pain following antibiotic treatment for acute otitis media. Clinical findings revealed otorrhea, VI cranial nerve palsy, and facial pain, raising suspicion of Gradenigo syndrome. MRI confirmed fluid collection in the petrous apex and compression of the V and VI cranial nerves. The patient started antibiotic, steroid, and anticoagulant therapy. Clinical improvement was gradual, with pain resolution within one week and nerve palsy resolving after three weeks. Gradenigo syndrome is a rare complication of acute otitis media.