Hyperbaric Oxygen Therapy in Lateral Sinus Thrombosis

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; ALCARAZ, A.; LOPEZ, A.; BARDACH, A.; CIAPPONI, A; SPIRA, C

Documento de Evaluación de Tecnologías Sanitarias

IECS

Año: 2012 p. 1 - 30

1668-2793

Cerebral venous sinus thrombosis (CVST) is less common than most types of strokes. It affects approximately 5 people per million annually. There may be multiple causes, but at least one cause may be identified - mostly a prothrombotic condition - in more than 85% of adult patients. Infectious causes account for 6 to 12 % of cases of adults with CVST and among them, the most commonly associated to it is middle ear otitis. Lateral sinus thrombosis (LST) is a complication of the middle ear otitis accounting for 6% of all intracranial complications of the suppurative ear diseases in the antibiotic age. The proximity of dural venous sinuses to the middle ear and to the mastoid cells predisposes them to thrombosis and to thrombophlebitis secondary to infection or inflammation of the middle ear or the mastoid. Severe headache, otalgia, pain in the mastoid area and intermittent high fever and papilloedema are considered specific signs and symptoms of LST. Intravenous administration of broad spectrum antibiotics and surgical drainage of the infections are the bases for the treatment. Technology Hyperbaric oxygen therapy (HOT) is in inhalation of 100 per cent oxygen within a pressurized hyperbaric chamber at more than one atmosphere. Purpose To assess the available evidence on the efficacy, safety and coverage policy related issues on the use of HOT in patients with lateral sinus thrombosis. Methods A bibliographic search was carried out on the main literature databases (MEDLINE, Cochrane, DARE, NHS EED, EMBASE, LILACS, TripDatabase, Up To Date), on Internet general search engines, in health technology assessment agencies and health systems. Priority was given to the inclusion of systematic reviews; controlled, randomized clinical trials (RCTs); health technology assessments and economic evaluations; clinical practice guidelines and coverage policies of other health systems. Results By using the previously described search strategies, no scientific publications were found on the effectiveness and safety of the HOT in lateral sinus thrombosis. One clinical practice guideline was found where patients with CVST and suspected bacterial infection are recommended to receiving the adequate antibiotic therapy and surgical drainage of the related purulent collection. Hyperbaric oxygen therapy is not mentioned as a therapeutic alternative for LST. Costs According to domestic sponsors, the cost of hyperbaric oxygen therapy is AR$ 7,500 (Argentine pesos, August 2012) every 20 sessions. Conclusions No publications supporting the use of hyperbaric oxygen therapy for the treatment of lateral sinus thrombosis have been found.