Otogenic Sigmoid Sinus Thrombosis: What Is the Role of Anticoagulation?
- 1 October 2002
- journal article
- Published by Wiley in The Laryngoscope
- Vol. 112 (10), 1726-1729
- https://doi.org/10.1097/00005537-200210000-00003
Abstract
The treatment of otogenic sigmoid sinus thrombosis with surgery and antibiotics is well established. However, the role of anticoagulation remains unstudied. The study reviews the signs, symptoms, radiological evaluation, surgical treatment, and medical management of patients with otogenic sigmoid sinus thrombosis treated with or without anticoagulation. Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus thrombosis. Patients were identified by a review of all medical and radiological records. Signs, symptoms, diagnostic studies, treatments, and outcomes were recorded. In addition, telephone follow-up was performed. RESULTS Nine patients were identified over a 6-year period from 1995 to 2001. Patients had a mean follow-up time of 9 months (range, 1-24 mo). Of the nine patients identified, eight patients (89%) had tympanostomy tube placement, six patients (67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall down mastoidectomy. Needle aspiration of the sinus was performed in four of nine patients (44%), and incision of the sinus in two of nine (22%). Treatment with broad-spectrum antibiotics occurred in all patients with a mean duration of 12 days (range, 2-22 d) intravenously and 7 days (range, 0-21 d) orally. Sixty-seven percent of patients (six of nine) were anticoagulated: Five patients received low-molecular-weight heparin, and one patient received heparin-coumadin. No mortality occurred in either the anticoagulated or non-anticoagulated group. One anticoagulated patient did have persistent headaches and otorrhea. Surgery and antibiotic therapy are the cornerstones of the management of otogenic sigmoid sinus thrombosis. However, the role of anticoagulation remains unclear. Because complications of embolization and persistent sepsis are low in otogenic sigmoid sinus thrombosis patients treated with or without anticoagulation, withholding anticoagulation in selected patients is reasonable. Serial imaging to monitor for thrombus progression is advisable.Keywords
This publication has 17 references indexed in Scilit:
- Cerebral Venous ThrombosisStroke, 1999
- Anticoagulation Therapy in Pediatric Patients With Sinovenous ThrombosisArchives of Neurology, 1998
- Lateral sinus thrombosis associated with otitis media and mastoiditis in childrenThe Pediatric Infectious Disease Journal, 1995
- Extracranial and intracranial complications of suppurative otitis media. report of 102 casesThe Journal of Laryngology & Otology, 1993
- Heparin treatment in sinus venous thrombosisThe Lancet, 1991
- Lateral sinus pathologyThe Journal of Laryngology & Otology, 1988
- Lateral sinus thrombosisThe Journal of Laryngology & Otology, 1987
- Lateral sinus thrombosis: A sometimes unexpected diagnosisThe Laryngoscope, 1985
- Cerebral venous thrombosis--a review of 38 cases.Stroke, 1985
- Lateral sinus thrombosis: A modern perspectiveThe Laryngoscope, 1982