"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."