| Abstract [eng] |
Introduction. Chronic otitis media with cholesteatoma is associated with recurrent purulent discharge and progressive bone destruction and may lead to rare yet serious complications, including mastoiditis, cerebral venous sinus thrombosis and intracranial abscesses. We present a case of chronic otitis media with cholesteatoma diagnosed at an advanced stage and complicated by mastoiditis and intracranial spread. Case report. A 5-year-old boy was admitted to the hospital with left-sided postauricular pain and mild swelling, purulent ear discharge and episodic headaches. The patient had been treated for otitis externa during the three months prior to hospitalization. Ear examination revealed a thickened, erythematous eardrum covered with purulent discharge. Urgent contrast-enhanced Magnetic resonance imaging demonstrated mastoiditis complicated by the left retroauricular abscess, cerebellar abscess and an extensive thrombosis of the superior sagittal, left sigmoid and transverse sinuses. Emergency tympanostomy, retroauricular abscess incision and drainage were performed. Broad-spectrum antibiotics and anticoagulation were initiated. Following the treatment, purulent discharge persisted daily from the postauricular incision and the middle ear. Two weeks after the initial surgery, a left-sided atticoantromastoidectomy was performed, cholesteatoma and two ossicular bones were removed. One month later, the patient was discharged. Discussion and conclusions. Post-COVID studies have reported a higher proportion of severe otogenic intracranial complications, including cerebral venous sinus thrombosis, raising discussion about possible associations with hypercoagulability, immune dysregulation and delayed diagnosis. Treatment of cerebral venous sinus thrombosis includes broad-spectrum antibiotic therapy, anticoagulation and surgical intervention in cases associated with mastoiditis, bone destruction, subperiosteal abscess or cholesteatoma. |
