Bilateral COM with right sided sigmoid sinus thrombosis and left postaural fistula in a child

Abstract

Chronic suppurative otitis media (COM) is a common pediatric condition that can occasionally lead to serious intracranial complications. Sigmoid sinus thrombosis is a rare but potentially life-threatening complication, often associated with cholesteatomatous disease. We report a case of a 10-year-old male presenting with bilateral ear discharge and progressive hearing loss for four years, associated with right-sided headache, neck pain, and intermittent fever. Otoscopic examination revealed advanced retraction changes with cholesteatoma in the left ear and a postaural fistula, while the right ear showed attic retraction with inflammation. Radiological evaluation with contrast-enhanced computed tomography of the brain and high-resolution computed tomography of the temporal bone demonstrated right sigmoid sinus thrombosis with involvement of the upper internal jugular vein, along with bilateral middle ear and mastoid disease. The patient was initially managed with intravenous antibiotics followed by right-sided modified radical mastoidectomy with type III tympanoplasty. The postoperative course was uneventful, with significant clinical improvement. This case highlights the aggressive nature of bilateral COM and underscores the importance of early diagnosis, appropriate imaging, and timely surgical intervention to prevent life-threatening intracranial complications.

Keywords

Chronic otitis media; Sigmoid sinus thrombosis; Cholesteatoma; Postaural fistula; Pediatric