The changing face of lateral sinus thrombosis

Lateral sinus thrombosis is a life threatening complication of middle ear disease, the presentation, diagnosis and management of which has seen many changes in recent times. While the introduction of antibiotics has been associated with a reduction in the incidence and associated morbidity/mortality of this complication, their use has also altered the clinical features of presentation, consequently diagnosis requires a high index of suspicion. Radiological advances, in particular magnetic resonance imaging and magnetic resonance venography, have improved our ability to diagnose this complication pre-operatively, and now are the diagnostic investigations of choice. Intraoperative sigmoid sinus exploration and removal of all necrotic clot are essential steps of surgical management together with appropriate antimicrobial treatment, however the role of anticoagulation therapy remains controversial. We present four recent cases of sigmoid sinus thrombosis and discuss the clinical presentation, investigation and management of this disease.