Sigmoid and Transverse Sinus Thrombosis as a Complication of Chronic Suppurative Otitis Media in a Child - Case Report and Review of Literature - Antibiotic-Anticoagulant Treatment

Sep 28, 2026

Uploaded by Levi

Chronic suppurative otitis media (CSOM) can progress to severe sinus thrombophlebitis when cholesteatoma is present and prompt diagnosis and treatment are delayed. A pediatric case details an 8-year-old girl with chronic left postauricular swelling, foul-smelling otorrhea, otalgia, then fever, headache, vomiting, and papilledema. Culture from drained suppuration guided management, while contrast CT and MRI/MRV demonstrated partial thrombosis involving the superior sagittal, left transverse, and sigmoid sinuses. Treatment combined tympanomastoidectomy and otomastoidectomy with antibiotics and anticoagulation, using rivaroxaban and vancomycin, followed by postoperative CT-confirmed favorable outcome and gradual neurological improvement.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Case presentation and diagnosis

Treatment approach and follow-up

Discussion and clinical message

Clinical Case Reports CASE REPORT OPEN ACCESS Sigmoid and Transverse Sinus Thrombosis asa Complication of Chronic Suppurative Otitis Media ina Child: A Case Report and Review of Literature Abdullah Nadeem1 | Hafiza Hafsa2 | Ruqaiya Shahid Raja3 | Mahad Shahid Raja4 | Muhammad Saad Abbas5 | Omer Javed Khan6 | Faisal Khalique7 | Riyan Imtiaz Karamat8 | Aymar Akilimali9 1Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan | 2Dow Medical College, Karachi, Pakistan | 3Shifa College of Medicine, Islamabad, Pakistan | 4Akhtar Saeed Medical College, Lahore, Pakistan | 5Aga Khan Medical College, Karachi, Pakistan | 6Central Park Medical College, Lahore, Pakistan | 7Lahore Medical and Dental College, Lahore, Pakistan | 8Rahbar Medical and Dental College, Lahore, Pakistan | 9Department of Research, Medical Research Circle (MedReC), Goma, Democratic Republic of Congo Correspondence: Aymar Akilimali ([aymarakilimali@gmail.com](aymarakilimali@gmail.com)) Received: 31 May 2025 | Revised: 7 December 2025 | Accepted: 14 December 2025 Keywords: antibiotic | anticoagulation management | chronic suppurative otitis media | complications | sigmoid sinus thrombosis ABSTRACT 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 20mg 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. 1 | Introduction Chronic suppurative otitis media (CSOM) is a major cause of preventable hearing loss, especially in socioeconomically deprived populations [1] . It takes place when tympanic membrane perforation leads to persistent middle ear inflammation, hearing loss, and otorrhoea. Topical antibiotics are the primary treatment, while surgery may be needed for persistent cholesteatoma | Abbreviations: AFB, acid-fast bacilli; CSOM, chronic suppurative otitis media; CT, computed tomography; ENT-HN, ear, nose, throat-head and neck; MRI, magnetic resonance imaging; MRV, magnetic resonance venography. | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original wor

FAQs

What complications can chronic suppurative otitis media lead to in children?

Chronic suppurative otitis media can lead to life-threatening sinus thrombosis and thrombophlebitis, particularly when cholesteatoma is involved.

How was the thrombosis evaluated and diagnosed in this case?

Diagnosis relied on clinical findings plus imaging. Contrast CT showed thrombosis involving the superior sagittal, left transverse, and sigmoid sinuses, and MRI/MRV supported left otomastoiditis and venous involvement.

What treatment was used and what was the outcome?

Management combined surgical drainage with tympanomastoidectomy/otomastoidectomy, antibiotic therapy (including vancomycin), and anticoagulation (rivaroxaban with dose adjustment). Postoperative imaging and clinical signs showed good prognosis with gradual improvement.

Sep 28, 2026

Uploaded by Levi