However, the findings at least raise, again, the question of why this link exists, Dr. Gurgel said. “Hearing loss, on one hand, could be just a correlation: those who have hearing loss, we know, often become more socially isolated (and) social isolation, in and of itself, is a risk factor,” he said. “Another thought is that there is a real neurobiological association between hearing loss and dementia, that when one person loses neurological function in one sensory domain, that may be a harbinger for a neurological decline in another domain.”
Explore This IssueMay 2013
Lateral Sinus ThrombosisAmerican Neurotology Society
In one case that drew attention at a session during the 48th Annual Spring Meeting of the American Neurotological Society, panelists discussed a 56-year-old diabetic man with a neck mass and otorrhea, complaining of neck stiffness and fever. The patient was found to be running a fever, with low blood pressure and a high heart rate, an elevated white count and edema. Greenish pus was running out of his ear and he had post-auricular swelling down into the neck. He was eventually found to have lateral sinus thrombosis (LST).
Panelists discussing the case said they would generally proceed conservatively with anti-coagulation, unless imaging showed a dire situation, noting that the standard is moving toward this approach. In this case, drainage was actually performed, along with anti-coagulation and IV antibiotics.
Fred Telischi, MD, chairman of otolaryngology at the University of Miami, who presented the case, said LST can be difficult to diagnose but that headaches, often accompanied by malaise, spiking fevers, chills and post-auricular edema, are common. “Headaches are a critical complaint, though non-specific,” Dr. Telischi said. “We should take it seriously if a patient presents like this, has headaches and some of these other symptoms.” Swelling of the optic nerve is also an important symptom to watch for, he said.
He said the goal in managing LST is to clear the infection but not necessarily to re-establish blood flow, with a needle aspiration done if necessary. If patients develop brain edema and intracranial hypertension, he said, consult with neurosurgery and take steps to reduce the pressure. Anti-coagulation, generally with IV heparin followed by subcutaneous heparin, is particularly appropriate when ICH and a decline in mental status are problems, Dr. Telischi.
In the case of a risk of septic emboli, more urgent steps should be taken, he said. “This is probably the one indication to ligate the internal jugular vein,” Dr. Telischi said.