title: Management of otogenic lateral sinus thrombosis.
abstract: OBJECTIVE
  To evaluate the changing clinical course and trends in management of otogenic lateral sinus thrombosis (OLST), in view of the rarity of the said lesion and antibiotic abuse.
  
  
  METHODS
  A retrospective case study was done in 6 patients referred to our tertiary care centre with OLST over a period of three years from May 2007 to May 2010: Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - a tertiary care university teaching hospital under central government of India. Medical records of all the patients were scrutinized and data pertaining to patient profile, type of chronic suppurative otitis media (CSOM), clinical course with any other complication and management were tabulated. The said data was scientifically analyzed w.r.t. current medical literature on the subject.
  
  
  RESULTS
  Clinically, it was observed that all patients had protracted CSOM - attico antral type, with history of rampant misuse of antibiotics. The attack of OLST in each case was triggered off by an acute attack of suppurative otitis media. Moreover, in all the cases OLST was masquerading as an intra-cranial complication, with no specific clinical features thereby causing missed diagnosis initially. All these patients were diagnosed by CT scan, and underwent modified radical mastoidectomy (MRM) with needle aspiration of sinus under antibiotic cover. The said treatment protocol resulted in excellent prognosis with no morbidity or mortality whatsoever. Pathologically, cholesteatoma was detected in 5 of the six cases with one case having only granulations.
  
  
  CONCLUSIONS
  In this era of antibiotic abuse, the clinical presentation of OLST has altered substantially, and mimics other intra-cranial complication with vague signs and symptoms. There are conflicting views in contemporary medical literature regarding management of OLST. In our experience, MRM with needle aspiration under antibiotic cover is the treatment of choice for all cases of OLST associated with CSOM attico antral disease/cholesteatoma disease.
authors.affiliation: Department of Otorhinolaryngology & Head-Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, New Delhi 110001, India; VMMC & Safdarjung Hospital, New Delhi, India. Electronic address: gbsnit@yahoo.co.in.
authors.forename: Gautam Bir
authors.initials: GB
authors.lastname: Singh
authors.affiliation: Department of Otorhinolaryngology & Head-Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, New Delhi 110001, India.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Rai
authors.affiliation: Department of Otorhinolaryngology & Head-Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, New Delhi 110001, India.
authors.forename: Sarvejeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Otorhinolaryngology & Head-Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, New Delhi 110001, India.
authors.forename: Radhamadhab
authors.initials: R
authors.lastname: Sahu
authors.affiliation: Department of Otorhinolaryngology & Head-Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, New Delhi 110001, India.
authors.forename: Rubeena
authors.initials: R
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000150:complications; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008416:Mastoid / Q000601:surgery*; D010035:Otitis Media, Suppurative / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Chronic suppurative otitis media; Otogenic lateral sinus thrombosis