Abstract
Objective: 1) Discuss the presentation, work up, and treatment of a series of pediatric patients presenting with otomastoiditis with sigmoid sinus thrombosis (OSST). 2) Review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis.
Method: Retrospective case series of 3 patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using Pubmed search terms “thrombosis and otitis media and anticoagulation” limited to English.
Results: Three patients were diagnosed with OSST. One patient presented with diplopia and otitic hydrocephalus. All patients were treated with anticoagulation following myringotomy with tubes and cortical mastoidectomy without thrombectomy. All patients were anticoagulated for 24 to 42 weeks with clinical recovery with resolution of thrombosis by MRI in less than 6 months. There were no major complications from anticoagulation use. Literature review of 50 patients with OSST showed that 60% had sigmoid aspiration or incision in addition to mastoidectomy, and only 64% of patients had anticoagulation. All patients had clinical recovery, with recanalization or resolution of clot in 16 patients.
Conclusion: The treatment of OSST is controversial. All patients presented had clinical recovery but 66% had anticoagulation and clot resolution in 19 out of 32. Two patients had hematoma with anticoagulation. This series and literature review highlights the controversy of surgical and medical management of OSST and the need for further investigation.
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