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Complications of mastoiditis with special emphasis on venous sinus thrombosis
Insights
Mastoiditis can lead to serious complications like intracranial venous sinus thrombosis in children. Early diagnosis with CT scans and surgical intervention alongside antibiotics are crucial for effective treatment.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Neurology
- Neuroradiology
Background:
- Mastoiditis, an infection of the mastoid bone, can present acutely or chronically.
- Chronic mastoiditis in children is often associated with cholesteatoma and lacks fever but presents with chronic otorrhea.
- Intracranial venous sinus thrombosis and cerebellar abscess are rare but severe complications of mastoiditis.
Observation:
- A review of 15 pediatric patients (1.5-14 years) with mastoiditis over a decade identified serious complications.
- Four children developed intracranial venous sinus thrombosis, and one had an intracerebellar abscess.
- Chronic mastoiditis cases (n=6) were linked to cholesteatomas, unlike acute cases (n=9).
Findings:
- Contrast-enhanced computerized tomography (CT) is vital for diagnosing these rare complications.
- Arteriography remains essential for surgical planning to assess venous patency due to anatomical variations.
- Optimal management involves antibiotics and surgical drainage for mastoiditis and its complications.
Implications:
- Highlights the importance of recognizing and managing severe intracranial complications of pediatric mastoiditis.
- Emphasizes the diagnostic utility of advanced imaging like CT and the role of arteriography in surgical decision-making.
- Underscores the necessity of a combined medical and surgical approach for optimal patient outcomes.
Abstract:
Two children with intracranial venous sinus thrombosis complicating mastoiditis prompted review of the experience with these disorders at the The Children's Memorial Hospital in Chicago over the past decade. Fifteen patients, 1.5 to 14 years of age, with mastoiditis were identified, including nine cases categorized as acute and six as chronic, the latter without fever but with chronic otorrhea. All six patients with chronic, but none with acute, mastoiditis were found to have cholesteatomas. Venous sinus thrombosis developed in four children and intracerebellar abscess in one child. Contrast-enhanced computerized tomography has proved valuable in the diagnosis of these rare, serious complications of mastoiditis in recent patients. Arteriography is still desired to confirm venous patency or occlusion prior to surgery because of well-documented developmental variations in venous drainage patterns. Optimal therapy of mastoiditis and its complications generally requires surgical drainage in addition to administration of antibiotics.