Sigmoid and Transverse Sinus Thrombosis as a Complication of Chronic Suppurative Otitis Media in a Child: A Case Report and Review of Literature

Chronic suppurative otitis media is an easily managed condition with potential for severe sinus thrombophlebitis complications secondary to cholesteatoma, if not diagnosed and treated promptly. Diagnosis relies on the culture and sensitivity of the drained suppuration, computed tomography (CT), and magnetic resonance imaging (MRI). Treatment entails a combination of all or some surgical, antibiotic, and anticoagulant use with postoperative follow-up. Our 8-year-old female patient presented with chronic left postauricular swelling with foul-smelling otorrhea and associated otalgia. More recently, she developed fever, headache, and vomiting. Fundoscopy noted papilledema. After ear examination, emergency incision and drainage were conducted with the suppuration sent for culture analysis. Tuberculosis was also ruled out. The patient had no history of dental caries. Contrast CT scan of the brain revealed features suggestive of partial thrombosis of the superior sagittal, left transverse sinus and sigmoid sinus extending up to the jugular vein. MRI and magnetic resonance venography (MRV) also indicated left otomastoiditis. Surgical treatment involved left-sided tympanomastoidectomy and otomastoidectomy. Anticoagulant Rivaroxaban was used 15 mg twice daily for 21 days. Postoperatively, the dosage was increased to 20 mg once daily for 3 months. Antibiotic vancomycin was administered preoperatively. Postoperative CT showed good prognosis. Postoperatively there was gradual improvement in headache and vision deterioration of right eye; fundoscopy showed improvement in papilledema, patient leukocyte counts also declined significantly, eventually to 13.4/μL. Anticoagulant and antibiotic therapy was continued. Some authors advocate only blood-brain barrier crossing antibiotics, while others employ surgical treatment. The risks involved with using anticoagulants must be carefully weighed before use. Our case presents classic clinical signs and symptoms.