Conservative nonsurgical treatment of a child with
otogenic lateral sinus thrombosis
Ella Even Tov, MD
, Alberto Leiberman, MD
, Ilan Shelef, MD
, Daniel M. Kaplan, MD
Department of Otolaryngology—Head & Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev,
PO Box 151, Beer-Sheva, Israel
Radiology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel
Received 20 February 2007
Abstract We present the case of a 5-year-old boy with otogenic lateral sinus thrombosis that developed after
acute mastoiditis, with no prior ear disease. He was treated with myringotomy and antibiotics alone,
with no surgical intervention. This approach was followed owing to his good general condition, the
prompt response to the antimicrobial treatment, and no evidence of suppurative disease. Sinus
recanalization was evident on the follow-up computed tomography 4 months later. We believe that in
selected cases of otogenic lateral sinus thrombosis, secondary to an acute ear infection with early
response to antibiotic therapy, conservative treatment may be considered and surgical intervention
may be withheld.
© 2008 Published by Elsevier Inc.
With the advent of antibiotics, intracranial complications
of otitis media, including otogenic lateral sinus thrombosis
(OLST), are considered rare [1,2]. However, OLST con-
tinues to be a life-threatening condition, with mortality
reaching 10% [3,4]. Management of OLST in the antibiotic
era has traditionally included antibiotic therapy and
mastoidectomy with evacuation of the thrombus, with or
without anticoagulation medication. In recent years, mod-
ifications of this surgical approach have been offered,
treating patients with mastoidectomy without evacuation of
the clot from lateral sinus [5,6]. Some recent reports propose
nonsurgical management of OLST [7-9].
We report a case of a child who developed OLST;
however, his prompt response to conservative antibiotic
therapy convinced us to pursue this strategy rather than
intervening surgically. We review the rationale and indica-
tions for this nonsurgical approach.
2. Case report
A 5-year-old white boy was transferred to a tertiary care
otolaryngology department from a community hospital, with
the diagnosis of OLST. His present illness started 17 days
previously when he complained of right-sided otalgia and
was treated with anesthetic eardrops by his general
physician. Two weeks later, he presented to the local
hospital with right otalgia, a protruded auricle, high fever,
and general weakness. The patient and parents denied
symptoms of headache and vomiting, as well as any prior ear
infections. The rest of his medical history was normal.
Erythema of postauricular area on the right was noted, with
an edematous tympanic membrane. White blood cell count
was 23 700/μL. He was hospitalized with the diagnosis of
acute mastoiditis, and parenteral ceftriaxone (1 g daily) was
administered. Although fever subsided during the following
3 days, postauricular swelling got worse. A cranial and
temporal bone computed tomographic (CT) scan with
contrast material was performed. The suspicion of OLST
arose after the CT scan, and he was transferred to our medical
center for surgical treatment.
Available online at www.sciencedirect.com
American Journal of Otolaryngology – Head and Neck Medicine and Surgery 29 (2008) 138 –141
Corresponding author. Department of Otolaryngology—Head &
Neck Surgery, Soroka University Medical Center, Ben Gurion University
of the Negev, Beer-Sheva, Israel, PO Box 151, Beer-Sheva 84101, Israel.
Tel: +972 54 7499234, +972 8 6400635; fax: +972 8 6403037.
E-mail addresses: firstname.lastname@example.org (E.E. Tov),
email@example.com (A. Leiberman), firstname.lastname@example.org (I. Shelef),
email@example.com (D.M. Kaplan).
0196-0709/$ – see front matter © 2008 Published by Elsevier Inc.