Thrombophlebitis of the head and neck caused by eosinophilic otitis media

OBJECTIVE: To describe the clinical course and treatment of a patient presenting with thrombophlebitis of the head and the neck with eosinophilic otitis media (EOM). PATIENT: The patient was a 32-year-old woman with bronchial asthma and chronic sinusitis. She was treated for EOM, which presented as intractable otitis media with viscous effusion. Subsequently, she experienced sudden onset of nausea and headache. No signs of improvement were observed after the intravenous administration of several antibiotics. Magnetic resonance imaging (MRI) revealed right thrombophlebitis extending from the sigmoid sinus to the jugular vein. INTERVENTIONS: Systemic administration of adrenocortical steroid hormone after intravenous antibiotic therapy. MAIN OUTCOME MEASURES: Radiologic features and patient symptoms. RESULTS: Intravenous antibiotic therapy was ineffective, but the patient's symptoms were relieved less than 1 day after the initiation of prednisolone treatment (30 mg/d for 5 d). MRI performed 3 days after treatment revealed that thrombophlebitis of the head and neck had disappeared. CONCLUSION: Adrenocortical steroid hormone therapy may be an effective treatment for thrombophlebitis with EOM. Chemoattractants activated by EOM might be associated with the pathogenesis of thrombophlebitis of the head and neck.