ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Surgery
This article is part of the Research TopicExploring Pediatric Oculo-Cranial Pressure Dynamics in ChildrenView all 3 articles
Treatment of increased intracranial pressure secondary to Otitic Hydrocephalus
Provisionally accepted
Esha Prakash
Ross O'Shea
Tais Estrela
Gena Heidary
A Eliot Shearer
Caroline Robson
Kim Hae-YoungAlfred Pokmeng See
Ryan Gise*- Boston Children's Hospital, Boston, United States
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ABSTRACT Objectives Otitic hydrocephalus is defined as increased intracranial pressure (ICP) secondary to acute mastoiditis with cerebral venous thrombosis, leading to visual morbidity from papilledema. As no standardized ophthalmological treatment for papilledema exists, this study aims to evaluate the impact of corticosteroids on visual and clinical outcomes. Methods This retrospective chart review includes children ≤18 years old, with otitic hydrocephalus and papilledema. Patients were evaluated by ophthalmology between July 2022 to July 2024 at a quaternary children's hospital. Data from ophthalmologic visits, neuroimaging and clinical courses were recorded. Results Fourteen patients (9 male [64%], 5 female) were identified; average age was 5.6 years (range 2-9). All were treated with acetazolamide, anticoagulation, and antibiotics. Two patients (14%) underwent otologic and neurosurgery. Twelve patients received corticosteroids; four (29%) needed further neurosurgery, while eight (64%) improved with corticosteroids alone. Visual acuity (VA), Frisen grade at presentation and time to corticosteroid initiation were not predictive of corticosteroid success. Patients who had corticosteroids only vs those who had surgery had a reduced length of stay. Five patients presented with retinal changes on optical coherence tomography (OCT) developed signs of optic disc atrophy at final appointment. Conclusion This series shows that there could be a potential role for systemic corticosteroids in reducing the hospital duration of patients with otitic hydrocephalus. It demonstrates the need for close follow-up, as corticosteroid success is difficult to predict. Patients presenting with retinal changes may be at higher risk for optic disc atrophy, potentially affecting visual function and requiring more frequent follow-up.
Keywords: Mastoiditis, Ophthalmology, Otitic hydrocephalus, Papilledema, Pediatrics
Received: 28 Oct 2025; Accepted: 31 Jan 2026.
Copyright: © 2026 Prakash, O'Shea, Estrela, Heidary, Shearer, Robson, Hae-Young, Pokmeng See and Gise. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ryan Gise
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