Learning Objectives: Initial surgical approach (antromastoidectomy) was not appropriate for this case. Right mastoidectomy, broad-spectrum antibiotics and anticoagulants has been the treatment of choice.

Introduction: Otogenic sigmoid sinus thrombosis is a rare complication of mastoiditis. This paper aims to offer clinical manifestation and management of sigmoid sinus thrombosis and facial palsy secondary to mastoiditis.

Methods: A 72-year-old patient known with right antromastoidectomy in other ENT Clinic, was reffered to our ENT Department with right-sided otalgia, headache and with right facial paralisys (loss of forehead wrinkles and inability to frown, inability to close the right eye, the corner of the mouth pulls down). Computed tomography with contrast administration indicated parafluide accumulations at right mastoid cells and thrombophlebitis modifications in sigmoid right sinus.

Results: This case demonstrates rare but serious sequel of mastoiditis: sigmoid sinus thrombosis and right facial paralysis. Middle ear secretation culture was positive with growth of Pseudomonas aeruginosa. In this case, a right mastoidectomy was associated with large spectrum antibiotics prolonged for 3 months. The anticoagulant therapy was established also.

Conclusions: The particularity of this case lies in that neurological symptoms had a slow recovery and also the difficulty of eradicating infection with Pseudomonas aeruginosa. The pacient will be re-evaluated periodically and also it requires long term follow-up using IRM examination.