Otitic Sepsis: Analysis of Twenty-One Cases and Anatomic Study

Abstract

The problem of otitic sepsis is one which frequently taxes the diagnostic acumen of the otologist to the utmost and necessitates the use of extensive therapeutic measures if optimum results are to be obtained. The literature on this subject is at times confusing, particularly with reference to the nature of the pathologic process in the sigmoid sinus. The terms sinus thrombosis and sinus phlebitis are unfortunately at times used interchangeably. The broader term "otitic sepsis" indicates an infection of the blood stream secondary to infection in the middle ear or the mastoid process. At the point of entrance of infection into the blood stream\p=m-\usually the sigmoid sinus\p=m-\thereis always phlebitis, and thrombus may or may not be present.The opinion of otologists as to the proper management of otitic sepsis is fairly uniform as far as the mastoid process and the sigmoid sinus are concerned. However, there is still some divergence of opinion as to whether and when ligation of the internal jugular vein should be done. The purpose of this study is to bring out any possible additional evidence which will help to answer this question and to present an anatomic study of the sigmoid sinus, which is of interest in connection with this subject. There is nothing new to be said as to symptoms, diagnosis or laboratory studies. However, these phases of the subject will be briefly touched on as concerns the group of cases of otitic sepsis to be reported on. SYMPTOMS AND DIAGNOSISThe outstanding clinical feature of sepsis complicating otitis media and mastoiditis is the septic, "picket-fence" type of temperature curve. When the temperature maintains a sustained high level it indicates the development of meningitis or overwhelming sepsis with metastatic lesions. A chill may or may not precede the elevation in temperature, this manifestation apparently depending on the age of the patient (table 1). The 7 patients over 15 years of age all had a definite chill