Lateral sinus thrombosis: a problem still with us

Abstract

Lateral sinus thrombosis is now a rare complication of ear disease in the developed world, since the advent of the widespread use of antibiotics. The classic picture is often modified by previous antibiotic treatment making diagnosis and management difficult. Lack of familiarity with this condition amongst present day otologists may lead to late diagnosis and treatment. We review three cases that we have managed recently and compare their clinical courses with the classic description of the disease.

Lateral sinus thrombosis

“…It has been reported in patient with a intact sigmoid plate indicating propagation by the thrombophlebitic spread through small emissary vein 4,6,10,11 . Lateral sinus thrombosis is ranked second to meningitis in the pre antibiotic era and lateral sinus thrombosis occurred largely as a complication of acute otitis media 10 Clinical features vary according to the stage of the disease.…”

“…With the extension of thrombophlebitis in to the jugular bulb and internal jugular vein, pain may be present in the neck, particularly on rotation The antibiotic era has seen a change in not only the clinical presentation of lateral sinus thrombosis, but also bacteriology 1 . Beta haemolytic streptococcus is no longer dominant organism 1,6 . Since chronic, rather than acute infection more commonly precede lateral sinus thrombosis, cultures characteristically yields mixed flora including bacteroids, staphylococcus, enterobacteriaceae, proteus, pseudomonas and other species 1,3,4 .…”

“…The decrease in incidence of lateral sinus thrombosis is due to early antibiotic therapy during initial otitis and mastoiditis 1,3,4,5 . The classical picture is often modified because of previous antibiotic therapy making the diagnosis of the occasional case of lateral sinus thrombosis more difficult by altering the expected clinical course 1,2, 6 .…”

Nonseptic and Septic Lateral Sinus Thrombosis: A Review

“…Septic lateral sinus thrombosis accounts for 2-20% of intracranial complications [20,21]. Numerous reports have documented a clear male predominance [15,[22][23][24].…”

“…Recent authors are of the opinion that with modern antibiotic therapy internal jugular vein ligation is not required [21,28,31]. Internal jugular vein ligation should reserved for those cases in which septicemia and embolisation which do not respond to initial surgery and antibiotic treatment [37,38].…”