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Published on: February 29, 2020
Otogenic lateral sinus thrombosis in children
Ireneusz Bielecki1, Mariusz Cofała, Józef Mierzwiński
1Department of Pediatric Surgery, Division of Otolaryngology, Medical University of Silesia, Upper Silesian Center for Child Health, Katowice, Poland. ibielecki@sum.edu.pl
Insights
Early surgical and pharmacologic treatment of pediatric lateral sinus thrombosis (LST), a rare complication of otitis media, leads to improved outcomes. Prompt intervention in children with LST is crucial for better prognosis and symptom resolution.
Area of Science:
- Otolaryngology
- Pediatric Neurology
- Infectious Diseases
Background:
- Lateral sinus thrombosis (LST) is a rare but serious complication of otitis media, particularly in pediatric patients.
- Neurologic symptoms can sometimes mask the otologic origin of LST, leading to diagnostic delays.
Purpose of the Study:
- To report the diagnostic and treatment experiences with pediatric lateral sinus thrombosis.
- To evaluate the clinical outcomes and prognosis following early intervention.
Main Methods:
- A retrospective review of five pediatric patients (ages 3-9) diagnosed with otogenic LST.
- Surgical intervention included canal wall intact mastoidectomy with tympanostomy tube insertion and exploration of lateral sinuses.
- Pharmacologic treatment involved broad-spectrum antibiotics and anticoagulation in four patients.
Main Results:
- Common presenting symptoms included headache, nausea, and vomiting, with varied otologic findings.
- All patients showed clinical improvement after surgical and pharmacologic treatment.
- Follow-up imaging revealed partial or complete recanalization of the lateral sinus in all cases, with no observed complications from anticoagulation.
Conclusions:
- Lateral sinus thrombosis is an uncommon complication of otitis media in children.
- Early diagnosis and prompt surgical and pharmacologic treatment are associated with a better prognosis.
- The study highlights the importance of considering LST in pediatric patients with neurologic symptoms potentially linked to otitis media.
Objective:
To present the results and experience with diagnosis and treatment of lateral sinus thrombosis, as a complication of otitis media, in a pediatric population.
Patients:
Five children, 2 girls and 3 boys, with age ranging from 3 to 9 years, identified as having otogenic lateral sinus thrombosis confirmed with clinical symptoms and radiologic findings.
Intervention:
All patients underwent canal wall intact mastoidectomy with tympanostomic tube insertion. In all patients, granulation tissues from mastoids were removed and exploration of the lateral sinuses by needle aspiration was performed. All patients were treated with broad-spectrum antibiotics, and 4 of 5 patients were administered anticoagulants.
Main Outcome Measures:
Clinical improvement, resolution of symptoms.
Results:
Patients with a diagnosis of otogenic lateral sinus thrombosis commonly presented with headache, nausea, and vomiting. Three patients had a bulging drum, 1 had otorrhea, and 1 had only retraction pocket. After surgery and pharmacologic treatment, clinical improvement was observed in all patients. Complication after anticoagulant administration was not observed. All patients were followed up from 12 to 36 months. All patients showed partial or complete recanalization on repeat imaging.
Conclusion:
Lateral sinus thrombosis is a rare complication of otitis media. In some cases, diagnosis is delayed because neurologic, rather than otologic, symptoms may dominate the presentation of the lateral sinus thrombosis. In our observation, the prognosis of lateral sinus thrombosis is better when surgical and pharmacologic treatments are instituted early.
