Socioeconomic Status on Diagnosing and Treating Spontaneous Cerebrospinal Fluid Leaks to the Temporal Bone

Background: Spontaneous CSF otorrhea can be difficult to diagnose, often leading patients to experience a delay in correct diagnosis. Globally, it is known that patients of lower socioeconomic statuses are prone to delayed diagnoses and inferior treatment options, resulting in worse complications. The objective of this study is to determine if patients' income and race affect the time to diagnosis, risk of complications, and management of spontaneous CSF leaks to the temporal bone.

Methods: Electronic medical record query of two neurotologists' patients at an urban, tertiary, academic medical center identified 151 patients with documented CSF otorrhea between January 2008 and December 2019. Patients with previous head injury, cranial neoplasm, craniotomy, or otologic surgery other than tympanostomy were excluded. One hundred and nineteen patients met inclusion criteria for spontaneous CSF otorrhea. Information on patients' demographics, presenting symptoms, imaging modalities, and treatment management was collected. Patient zip codes and 2018 census data were used to extrapolate median household income. The two predominant racial groups were Caucasian and African American. Therefore, statistical tests that involved race included patients who identified with either of these two groups. Logistical regression and Fisher's exact tests were performed for binary outcomes. Kendall's tau-B and Fisher's exact tests were performed for numerical outcomes.

Results: The average income was $55,700 with a standard error of $1,621. Forty-nine African American and 61 Caucasian patients were included in the study. There was no association between income and race (p = 0.22). There was no association between income and time to diagnosis or time to surgery (p = 0.35 and0.96, respectively). Likewise, there was no association between race and time to diagnosis or time to surgery (p = 0.16 and 0.41, respectively). The probability of preoperative seizure was not the same for each group (p < 0.05). Four patients had a history of seizures, all of whom were African American. Income and race were not found to be associated with preoperative likelihood of meningitis (p = 0.71 and 0.77, respectively). Neither income nor race was associated with receiving dual preoperative imaging, such as magnetic resonance and computed tomography versus receiving only one or neither form of imaging. Income and race were not associated with whether a patient received a magnetic resonance venography (p = 0.96 and 0.28, respectively). Income and race were not associated with the likelihood that a patient would undergo another CSF leak repair or a ventriculoperitoneal shunt placement (p = 0.60 and 1, respectively). Income and race were not found to be associated with time between the CSF leak repair and the last follow-up appointment (p = 0.62, both).

Conclusion: Neither income nor race have an association with time to diagnosis, time to surgery, or extent of preoperative imaging. Race was found to be associated with the likelihood of preoperative seizure. Collaboration with other health care teams is necessary to yield more generalizable conclusions.

Publication History

Article published online:
12 February 2021