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Contemporary management of pediatric lateral sinus thrombosis: a twenty year review
Joshua K Au1, Stewart I Adam, Elias M Michaelides
1Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, CA, USA.
Insights
Pediatric otogenic lateral sinus thrombosis is a rare but treatable complication of ear infections. Prompt diagnosis and treatment with antibiotics and surgery are crucial for favorable outcomes in children.
Area of Science:
- Otolaryngology
- Pediatric Neurology
- Infectious Diseases
Background:
- Otogenic lateral sinus thrombosis (OLST) is a rare but serious complication of otologic infections in children.
- Early recognition and appropriate management are critical for improving patient outcomes.
Observation:
- A literature review of 104 pediatric cases (1993-2011) identified fever, headache, and otalgia as common symptoms.
- CT and MRI demonstrated high sensitivity (87% and 100%, respectively) for diagnosing OLST.
- Bacterial infections, commonly Streptococcus and Staphylococcus species, were identified in 46% of cases.
Findings:
- Management typically involved broad-spectrum antibiotics (100%) and mastoidectomy (94%).
- Sinus manipulation was performed in 50% of cases, and anticoagulation in 57%.
- The mortality rate was low (1%), with morbidities including cranial nerve palsy and hearing loss in 10% of patients.
Implications:
- OLST requires a high index of suspicion in pediatric patients with otologic disease.
- Aggressive management with antibiotics and surgical intervention is recommended.
- The role of anticoagulation in OLST warrants further investigation.
Objectives:
A case of pediatric otogenic lateral sinus thrombosis is reported, followed by a substantive literature review.
Design:
104 patients were reviewed, culled from published case reports from 1993 to 2011 on the PubMed database.
Methods:
All full text case reports on the PubMed database from 1993 to 2011 with patients less than or equal to 16 years of age that outlined specific treatments were included.
Results:
73% of patients were male and average age of presentation was 7.7 years. The most common symptoms were fever, headache, and otalgia, while the most common signs included otorrhea and neck stiffness. CT scans had a sensitivity of 87% and MR studies had a sensitivity of 100%. Single bacterial organisms were isolated in 46% of cases, with beta hemolytic streptococcus, streptococcus pneumoniae, and staphylococcus aureus being most common. Management included broad spectrum antibiotics (100%), mastoidectomy (94%), manipulation of the thrombosed sinus (50%), and anticoagulation (57%). The mortality rate was one in 104 patients. Morbidities occurred in 10% of patients and included cranial nerve palsy, sensorineural hearing loss, stroke, and septic hip joint.
Conclusion:
Lateral sinus thrombosis is a rare but treatable complication of otologic disease in the pediatric population, warranting a high index of suspicion. Management should include broad spectrum antibiotics and surgical removal of all perisinus infection. Anticoagulation is not definitively associated with improved outcomes and warrants further investigation.
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