Abstract
Objectives
Otogenic lateral sinus thrombosis (LST) is a rare but serious intracranial complication of acute or chronic otitis media (OM). Mortality rates for LST are quoted as 8–25% in most recent larger case series. Controversy exists regarding the surgical and medical management of LST. We sought to clarify this by reviewing our experience in patients who presented with otogenic LST in the past 5 years.
Methods
A retrospective chart review was conducted. 7 patients were identified and charts were examined for presentation, co-existing intracranial complications, treatment, cultured organisms, and outcome.
Results
Patients most commonly presented with fever (5/7), otalgia (5/7), and mastoid tenderness (4/7). Co-existing intracranial complications were present in 4/7 patients, including meningitis (1/7), epidural abscess (2/7), otitic hydrocephalus (2/7), and cavernous sinus thrombosis (1/7). All patients received IV antibiotics and underwent mastoidectomy with unroofing of the sigmoid sinus, and tympanostomy tube placement. Thrombectomy was not performed on any patient. Anticoagulation was used on 5/7 patients without complication. Streptococcus sp. was the most common organism isolated (2/7). All patients recovered well without major sequelae. One patient with cavernous sinus thrombosis and otitic hydrocephalus had a persistent right visual field deficit.
Conclusions
In this limited series, we demonstrate good outcomes by emergently treating LST from an otitic source with mastoidectomy and unroofing of the sigmoid sinus, IV antibiotics, and selective anticoagulation. We did not find thrombectomy to be necessary.
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