Global Prevalence, Recurrence, and Risk Factors Associated With Spontaneous CSF Otorrhea-A Meta-analysis

To assess the prevalence, postsurgical recurrence, and risk factors associated with spontaneous cerebrospinal fluid (sCSF) otorrhea.

PubMed, Embase, Web of Science, and ScienceDirect were systematically searched for studies from inception to November 2024.

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.

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.

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.