-Case Reports-

A Case of Headache Attributed to Otitis Media Chronica Cholesteatomatica with Cerebral Sigmoid Sinus Thrombosis

Kazuhiro Usuda¹, Masanori Sakamaki¹, Eriko Mokuno² and Yasuo Katayama¹

¹Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
²Department of Head & Neck and Sensory Organ Science, Graduate School of Medicine, Nippon Medical School

Otitis media chronica cholesteatomatica with cerebral sigmoid sinus thrombosis is an important differential diagnosis in the evaluation of headache. We describe a 31-year-old Filipino man with chief complaints of headache, otalgia, vomiting, and vertigo, and no significant past medical history. Two years before admission he stuffed tissues into the right external auditory canal because of a noise in the street on the night of the New Year's festival and sometimes had right ear discharge. One month before admission he had a right occipital headache with right otalgia and fever. One day before admission he vomited. Vertigo developed on the day of admission. On physical examination at admission, the patient was somnolent and had a body temperature of 36.9°C, and meningeal signs were obvious. Magnetic resonance of the brain revealed right otitis media chronica cholesteatomatica and right cerebral sigmoid sinus thrombosis. Computed tomography of the skull base revealed that the tympanic cavity and mastoid air cells were filled with a mass of soft-tissue density invading toward the sigmoid sinus. Cerebrospinal fluid examination showed a cell count of 32/3 mm³. The patient's level of consciousness and symptoms improved after administration of ampicillin and ceftriaxone sodium. A diagnosis of "headache attributed to disorder of ears," with The International Classification of Headache Disorders, 2^nd edition (ICHD-II) code 11.4, was made on the basis of symptoms and imaging findings. Otitis media chronica cholesteatomatica had invaded toward the sigmoid sinus and was thought to be the cause of cerebral sigmoid sinus thrombosis and meningitis. Six weeks after admission the patient underwent mastoidectomy and tympanoplasty to cure the cholesteatoma and prevent recurrence of inflammation. The postoperative progress was satisfactory. In cases of headache with otalgia, "headache attributed to disorder of ears" should be considered.

J Nippon Med Sch 2008; 75: 340-343

Keywords
headache, otalgia, otitis media chronica cholesteatomatica, cerebral sigmoid sinus thrombosis, meningitis

Correspondence to
Kazuhiro Usuda, MD, Department of Internal Medicine (Divisions of Neurology, Nephrology, and Rheumatology), Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
usuda@nms.ac.jp

Received, March 28, 2008
Accepted, July 8, 2008