Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 709-713 (doi:10.1542/peds.2008-0280)
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ARTICLE

Lateral Sinus Thrombosis as a Complication of Otitis Media: 10-Year Experience at the Children's Hospital of Philadelphia

Christina B. Bales, MDa, Steven Sobol, MDb, Ralph Wetmore, MDc and Lisa M. Elden, MDc

a Departments of General Pediatrics
c Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital, Atlanta, Georgia

OBJECTIVES. Lateral sinus thrombosis is a rare intracranial complication of otitis media that is traditionally described in countries with poor access to medical care. Our goal was to describe the clinical presentation, management, and outcome of patients diagnosed with lateral sinus thrombosis in a US tertiary care center and to highlight the clinically relevant differences in presentation between these patients and those described in previous reports.

PATIENTS AND METHODS. The medical charts of 13 patients diagnosed with otogenic lateral sinus thrombosis were reviewed. These patients were identified from a manual search of 156 subjects with International Classification of Diseases, Ninth Revision codes corresponding with a diagnosis of mastoiditis or thromboembolism over a 10-year period (1997–2007) at the Children's Hospital of Philadelphia.

RESULTS. In contrast to previous reports in the literature, the majority of patients in this series exhibited cranial neuropathies and signs of raised intracranial pressure. Nearly all of the patients had a history of acute otitis media treated with antibiotics in the weeks preceding admission. However, many patients denied high fevers or active otomastoid symptoms, which are classically associated with lateral sinus thrombosis. The diagnosis was made in all of the children by using computed tomography and MRI/venography. Treatment strategies included myringotomy tube placement, simple mastoidectomy, intravenous antibiotics, and anticoagulation. Posthospitalization follow-up data revealed no significant long-term complications.

CONCLUSIONS. Despite appropriate antibiotic therapy, lateral sinus thrombosis and other intracranial complications of otitis media are still a threat to children in the modern era. Neurologic, rather than otologic, symptoms may dominate the presentation of otogenic lateral sinus thrombosis. Thus, a high index of suspicion may be critical for ensuring timely diagnosis of this rare condition.

Key Words: lateral sinus thrombosis • otitis media • otitic hydrocephalus • mastoiditis • thromboembolism • venous sinus thrombosis

Abbreviations: LST—lateral sinus thrombosis • ICP—intracranial pressure • AOM—acute otitis media • CHOP—Children's Hospital of Philadelphia • CT—computed tomography • MRV—magnetic resonance venography • MRA—magnetic resonance angiography

Accepted Jun 6, 2008.


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