Otogenic Lateral Sinus Thrombophlebitis in Children as an Acute Otitis Media Complication
Authors:
Z. Kabelka; Hadačová I.l; M. Jurovčík
Authors‘ workplace:
Oddělení klinické hematologie FN Motol, Praha
; ORL klinika 2. LF UK a FN Motol, Praha
přednosta doc. MUDr. Z. Kabelka
Published in:
Otorinolaryngol Foniatr, 56, 2007, No. 2, pp. 82-87.
Category:
Original Article
Overview
Sinus sigmoideus (lateral sinus) thrombophlebitis (LTS), a rare but potentially devastating complication of otitis media, is managed by broad spectrum antibiotics, surgery and anticoagulation. The management of intracranial dural sinuses thrombosis/thromboflebitis is still controversial and ambiguous. Traditionally, post-operative anticoagulation is achieved by intravenous low-molecular weight heparin derivatives followed by oral warfarin. There has been minimal literature to date regarding their use for the management of LST.
Study design:
A retrospective review was conducted of 7 children of otogenic LTS admitted between 1993 and 2005 to our division. All patients underwent i.v. antibiotics, anticoagulation therapy, and 6 of them mastoid surgery. We describe the inical symptoms, effectiveness of antithrombotic therapy, and outcome.
Conclusion:
In all of our children LTS was the result of acute otitis media. The age of them was by chance just between 6 and 7 years of age, there wasn’t sex prevalence, but in 6 cases the right side was affected. No one suffered from frequent acute otitis media, nor chronic one. Magnetic resonance imaging plays a major role in determining diagnosis and treatment plans. The treatment was succesful in all cases, conservative surgical mastoid intervention including eradication of the perisinus absceses seems to be effective.
In our cases, antithrombotic therapy has been found to be a safe and effective treatment. We performed careful antiXa/INR controls and didn’t observe any hemorrhagic complications. Angio-MRI showed recanalization of the sinuses in all patients (6 patients - average 33 days, 1 girl @ of a year). There was no additional mortality.
Key words:
lateral sinus thrombosis, sigmoid sinus thrombosis, thrombophlebitis, intracranial complication, anticoagulation.
Sources
1. Bento, R, de Brito R, Ribas G. C.: Surgical management of intracranial complications of otogenic infection. Ear Nose Throat. J., 85, 2006, s.. 36-39.
2. Bradley, D. T., Hashisaki, G. T., Mason, J. C.: Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation? Laryngoscope, 112, 2002, s. 1726-1729.
3. Cipri, S., Gangemi, A., Campolo, C., Cafarelli, F., Gambardella, G.: High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study. J. Neurosurg. Sci., 42, 1998, s. 23-32.
4. Hafidh, M. A., Keogh, I., Walsh, R. M., Walsh, M., Rawluk, D.: Otogenic intracranial complications. a 7-year retrospective review. Am. J. Otolaryngol., 27, 2006, s. 390-395.
5. Hybášek, I.: Ušní, nosní a krční lékařství. Galén, Karolinum, 1999, s. 172.
6. Iseri, M., Aydn, O., Ustundag, E., Keskin, G., Almac, A.: Management of lateral sinus thrombosis in chronic otitis media. Otol. Neurotol., 27, 2006, s. 1098-1103.
7. Kuczkowski, J., Dubaniewicz-Wybieralska, M., Przewozny, T., Narozny, W., Mikaszewski, B.: Otitic hydrocephalus associated with lateral sinus thrombosis and acute mastoiditis in children. Int. J. Pediatr. Otorhinolaryngol., 70, 2006, s. 1817-1823.
8. Manolidis, S., Kutz, J. W. Jr: Diagnosis and management of lateral sinus thrombosis. Otol. Neurotol., 26, 2005, s. 1045-1051.
9. Migirov, L., Duvdevani, S., Kronenberg, J.: Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol., 125, 2005, s. 819-822.
10. Přecechtěl, A., Hladký, R., Kotyza, F., Sedláček, K.: Základy otolaryngologie. SZN Praha, 1959, s. 600.
11. Shah, U. K., Jubelirer, T. F., Fish, J. D., Elden, L. M.: A caution regarding the use of low-molecular weight heparin in pediatric otogenic lateral sinus thrombosis. Int. J. Pediatr. Otorhinolaryngol., 23, 2006, [Epub ahead of print].
12. Seven, H., Ozbal, A. E., Turgut, S.: Management of otogenic lateral sinus thrombosis. Am. J. Otolaryngol., 25, 2004, s. 329-333.
13. Takami, T., Suzuki, T., Tokuno, H., Egashira, M., Tsuyuguchi, N., Komiyama, M., Hakuba, A.: A case report of dural sinus thrombosis: direct thrombolytic therapy using endovascular surgery. Abstrakt No Shinkei Geka. 23, 1995, s. 321-325.
14. Weber, J., Spring, A.: Unilateral decompressive craniectomy in left transverse and sigmoid sinus thrombosis. Zentralbl. Neurochir., 65, 2004, s. 135-140.
15. Wong, I., Kozak F. K., Poskitt, K., Ludemann, J. P., Harriman, M.: Pediatric lateral sinus thrombosis: retrospective case series and literature review. J. Otolaryngol., 34, 2005, s. 79-85.
16. Monagle, P., Chan, A., Missicote, P., Chalmers, E., Michelson, A. D.: Antithrombotic therapy in children. Chest, 126, 2004, s. 645S-687S
17. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David, M., Humphreys, P., Langevin, P., MacDonald, E. A., Meaney, B., Shevell, M., Sinclair, D. B., Yager, J., Gillett, J.: Cerebral sinovenous thrombosis in children. NEJM, 345, 2001, s. 417-423.
Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
2007 Issue 2
Most read in this issue
- Oroantral and Oronasal Communication Closure Possibilities Summary
- The Arnold‘s Reflex
- Head and Neck Liposarcomas
- Systemic Absorption of Adrenalin after Topical Administration on Nasal Mucosa