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Meta-Analysis
. 2025 Oct;173(4):797-811.
doi: 10.1002/ohn.1314. Epub 2025 Jun 12.

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

Srivatsa Surya Vasudevan  1 , Victor Albornoz  1 , Sydney Schwab  2 , Gauri Mankekar  1
Affiliations
Meta-Analysis

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

Srivatsa Surya Vasudevan et al. Otolaryngol Head Neck Surg. 2025 Oct.

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.

Keywords: idiopathic CSF otorrhea; spontaneous CSF leak; spontaneous cerebrospinal fluid otorrhea; tegmen dehiscence CSF leak; temporal bone CSF leak.

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References

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