Management of lateral sinus thrombosis

Objectives: Review the clinical signs and symptoms, management, bacteriolog y and outcomes of patients treated for lateral sinus thrombosis. Study Desi gn: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis. Methods: All charts from 1993 through 1998 coded for sinus thrombosis, meni ngitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoide ctomy were reviewed. Operative reports, radiological examinations, laborato ry data, culture data and other pertinent data were reviewed. Results: The presenting symptoms ranged from headache to mental status changes. All pati ents had a history of chronic ear disease and all had at least one addition al intracranial complication. The range of additional intracranial complica tions included otitic hydrocephalus, epidural abscess, and brain abscess. A ll of the infections were polymicrobial, with a predominance of anaerobes, There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusi on, ventriculoperitoneal shunt and nutritional supplementation. Conclusion: in patients with otologic disease, complaints of headache, earache or phot ophobia should warrant an evaluation. The presence of lateral sinus thrombo sis mandates further investigation for additional intracranial complication s. Conservative surgical intervention, consisting of removal of all perisin us infection and needle aspiration of the sinus, has been found to be effec tive. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of su spicion.