The Journal of Medical Sciences

Register      Login

VOLUME 9 , ISSUE 1-4 ( January-December, 2023 ) > List of Articles


Internal Jugular Vein Thrombosis Following Cortical Mastoidectomy in Coronavirus 2019 Era

Manoj Kumar Nagarajan, Rajiv R Sanji, Srirangaprasad Krishnaswamy

Keywords : Coronavirus disease 2019, Chronic suppurative otitis media, Intracranial complication of chronic suppurative otitis media, Internal jugular vein thrombosis, Sigmoid sinus thrombosis

DOI: 10.5005/jp-journals-10045-00228

License: CC BY-NC 4.0

Published Online: 08-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Forward-lying sigmoid sinus and injury during cortical mastoidectomy are complications every otologist bears in mind while operating. Pseudomonas infection of the middle ear cleft is difficult to eradicate. Following coronavirus disease 2019 (COVID-19), there is a hypercoagulable state which surgeons have to take into account while caring for affected individuals. Here is a case with all three problems, necessitating prolonged treatment. Case description: We report the clinical course and management of a teenage child who developed unilateral near-complete thrombosis of the internal jugular vein (IJV), jugular bulb, and partial thrombosis of distal sigmoid sinus—with a short segment thrombus—following myringoplasty and attempted cortical mastoidectomy. She developed a severe throbbing headache postoperatively (post-op). Imaging showed hypoplastic transverse and sigmoid sinus on the opposite side, aberrant anterior, and laterally placed sigmoid sinus on the operated side. Although the child had no history of upper respiratory tract infection/COVID-19 infection preoperatively, post-op measured COVID-19 antibody levels were elevated. The patient was treated with intravenous and oral anticoagulants, and antibiotics, leading to a complete resolution of symptoms. Conclusion: In the COVID-19 era, seemingly common problems may be amplified and more difficult to manage. In this report, we illustrate a problem which may be faced by the otologist—to raise awareness and improve clinical care.

  1. Mas JL, Meder JF, Meary E, et al. Magnetic resonance imaging in lateral sinus hypoplasia and thrombosis. Stroke 1990;21(9):1350–1356. DOI: 10.1161/01.STR.21.9.1350
  2. Miesbach W, Michael M. COVID-19: coagulopathy, risk of thrombosis, and the rationale for anticoagulation. Clin Appl Thromb Hemost 2020;26:107602962093814. DOI: 10.1177/1076029620938149
  3. Karaca CT, Sema ZT, Hulya KN. Analysis of anatomic variations in temporal bone by radiology. Int Adv Otol 2012;8(2):239–243.
  4. InVesalius (version 3.1.99994). Debian11 stable. Accessed September 14, 2021.
  5. Damak M, Crassard I, Wolff V, et al. Isolated lateral sinus thrombosis: a series of 62 patients. Stroke 2009;40(2):476–481. DOI: 10.1161/STROKEAHA.107.509711
  6. Viswanatha B, Thriveni CN, Naseeruddin K. Nonseptic and septic lateral sinus thrombosis: a review. Indian J Otolaryngol Head Neck Surg 2014;66(1):10–15. DOI: 10.1007/s12070-011-0422-4
  7. Kale US, Wight RG. Primary presentation of spontaneous jugular vein thrombosis to the otolaryngologist–in three different pathologies. J Laryngol Otol 1998;112(9):888–890. DOI: 10.1017/s0022215100141982
  8. Bardley DT, Hashisaki GT, Mason JC. Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation? Laryngoscope 2002;112(10):1726–1729. DOI: 10.1097/00005537-200210000-00003
  9. Seven H, Ozbal AE, Turgut S. Management of otogenic lateral sinus thrombosis. Am J Otolaryngol 2004;25(5):329–333. DOI: 10.1016/j.amjoto.2004.04.005
  10. Vartiainen E, Kansanen M. Tympanomastoidectomy for chronic otitis media without cholesteatoma. Otolaryngol Head Neck Surg 1992;106(3):230–234. DOI: 10.1177/019459989210600304
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.