Delayed otogenic hydrocephalus after acute otitis media in pediatric patients: the changing presentation of a serious otologic complication.
CONCLUSIONS
The clinical presentation of otogenic dural sinus thrombosis (DST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. Morning episodes of vomiting and/or headache, visual impairment and a history of AOM seem to be indicative of otogenic hydrocephalus. We therefore advocate that the MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of a potentially life-threatening complication.


OBJECTIVE
To describe the frequency, pathognomonic signs, clinical course and outcome of otogenic hydrocephalus and DST as complications of AOM in pediatric patients.


METHODS
We undertook a retrospective chart review of all pediatric patients (age 1-14 years) treated for otitis media and its complications at an academic medical center between 1999 and 2003. The main outcome measures were otologic and ophthalmologic findings and CT and MRI scans at the beginning of treatment and 3 months later.


RESULTS
We report on five cases with otogenic DST following AOM. All but one of them presented initially with diplopia caused by otogenic hydrocephalus. In four cases the otologic complaints had already disappeared by the time of MRI confirmation of the diagnosis. Only one child was referred with severe otologic symptoms. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our cases, even after intensive i.v. antibiotic treatment, only surgery led to a significant improvement in the clinical condition.
Koitschev
Assen
A
Department of Otorhinolaryngology and Head and Neck Surgery, University of TübingenTübingen, Germany. assen.koitschev@med.uni-tuebingen.de
Simon
Christian
C
Löwenheim
Hubert
H
Kumpf
Matthias
M
Besch
Dorothea
D
Ernemann
Ulrike
U
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007223:Infant; D008279:Magnetic Resonance Imaging; D008417:Mastoiditis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D010033:Otitis Media / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents