Otogenic Lateral Sinus Thrombosis: Controversies and Current Management Strategies

Area of Science:

• Otolaryngology
• Neurology
• Infectious Diseases

Background:

• Otogenic lateral sinus thrombosis (OLST) is a rare, severe intracranial complication of middle-ear infections.
• Current management, especially anticoagulation, lacks standardized guidelines despite advances in treatment.
• Optimal treatment strategies for OLST remain a subject of clinical debate.

Purpose of the Study:

• To review and synthesize current evidence on the management of otogenic lateral sinus thrombosis (OLST).
• To identify core treatment components and evaluate the role of anticoagulation in OLST.
• To propose a management algorithm for OLST based on available data.

Main Methods:

• Structured narrative review of English-language human studies from January 2015 to January 2025.
• PubMed database search, with subsequent record merging and deduplication.
• Analysis of seven eligible studies involving 140 confirmed OLST patients, excluding case reports and reviews.

Main Results:

• Most studies focused on pediatric populations; clinical presentations were often atypical due to prior antibiotic use.
• MRI/MRV was superior to CT for thrombus assessment and follow-up; antibiotics and surgical source control were standard treatments.
• Anticoagulation, typically with low molecular weight heparin, was inconsistently applied, with varied indications and durations.

Conclusions:

• Individualized OLST management is crucial, considering disease severity, thrombus extent, and patient risk factors.
• Essential treatments include antibiotics and source control; anticoagulation should be selectively considered.
• A proposed management algorithm requires validation through prospective multicenter studies.