Pediatric otogenic cerebral venous sinus thrombosis
Patients and Methods: a retrospective analysis of medical records of children with acute otitis media, exacerbation of chronic otitis media, mastoiditis and extra- and intracranial complications was conducted. All children were hospitalized from 2009 to 2019. The following indicators were studied: age and gender characteristics of children with otogenic complications; the parameters of clinical, laboratory, microbiological, X-ray imaging, and the prevalence of pediatric otogenic cerebral sinus thrombosis among all forms of otogenic complications. Results: during the study period, 6123 patients with purulent-inflammatory pathology of the ear were treated. Otogenic complications were verified in 135 children (mean age 5.99±0.34 years), otogenic cerebral venous sinus thrombosis was detected in 17 (12.6%) patients. Parents independently conducted the treatment for 3 (17.6%) children, treatment under the pediatrician supervision was carried out for 6 (35.3%) children, under the otorhinolaryngologist supervision - for 8 (47%) children. In all cases, the anamnesis presented the absence of laboratory and X-ray diagnostics at the stage of treatment and control of the AOM recovery in outpatient conditions. Upon admission, 17 (100%) patients had complaints about the ear pain, 14 (82.3%) patients complainted about the headache, and 4 (23.5%) patients noted the purulent discharge from the ear. Swelling, pitting edema, moderate hyperemia along the posterior edge of the mastoid process were recorded in 5 (29.4%) children, hyperemia, significant tenderness on palpation of the mastoid process tip - in 3 (17.6%) children. The examination and treatment of children was conducted using an interdisciplinary approach. CT and MRI with contrast were performed for suspected intracranial complication and thrombosis. Various types of defects in sigmoid sinus passage of contrast. All children underwent emergency surgical interventions and were prescribed with antibacterial and anticoagulant therapy. All patients were discharged recovered, and the control CT revealed complete recanalization of cerebral vessels. Conclusions: the incidence of otogenic cerebral venous sinus thrombosis was 12.6% of all forms of otogenic complications. Untimely visit to a doctor for otitis media, uncontrolled self-treatment, insufficient alertness of an outpatient doctor were the most common causes of otogenic cerebral venous sinus thrombosis. An interdisciplinary approach allows to reduce the risk of septic complications, adverse outcomes and achieve complete recovery.