Global Prevalence, Recurrence, and Risk Factors Associated With Spontaneous CSF Otorrhea—A Meta‐analysis
Srivatsa Surya Vasudevan, Victor Albornoz, Sydney Schwab, Gauri Mankekar
Abstract
OBJECTIVE: To assess the prevalence, postsurgical recurrence, and risk factors associated with spontaneous cerebrospinal fluid (sCSF) otorrhea. DATA SOURCES: PubMed, Embase, Web of Science, and ScienceDirect were systematically searched for studies from inception to November 2024. REVIEW METHODS: Random effect model meta-analysis was performed to estimate the pooled effect sizes of geographical prevalence, recurrence rates, and risk factors associated with sCSF otorrhea. We also performed a sensitivity analysis, metaregression, and publication bias assessment. RESULTS: In total, 24 out of 466 studies were included and comprised 1059 patients with cerebrospinal fluid (CSF) otorrhea. The prevalence rate of sCSF otorrhea among all CSF otorrhea patients was estimated at 37.8% (95% CI: 23.9%-54.1%). Geographically, the prevalence of sCSF otorrhea was higher in North America than in Europe (46.5% vs 16.8%), whereas recurrence rates were similar (10.7% vs 10.6%). The postsurgical recurrence rate of sCSF otorrhea was 10.3% (95% CI: 7.5%-13.8%). The most prevalent risk factors were obesity (73.9%, 95% CI: 63.9%-81.9%), hypertension (63.4%, 95% CI: 54.2%-71.7%), empty sella (49.3%, 95% CI: 38.5%-60.2%), and obstructive sleep apnea (OSA) (37.6%, 95% CI: 24.0%-53.5%). On metaregression, both OSA (-0.09, P = .03) and prior history of meningitis (-0.05, P = .004) were negatively associated with male gender. This indicates a greater association between risk factors for sCSF otorrhea and the female gender. CONCLUSION: This meta-analysis is the first to estimate the prevalence and postsurgical recurrence of spontaneous CSF otorrhea. This study also highlights the prevalent risk factors associated with sCSF otorrhea.