Audiometric Outcomes after Surgery for Spontaneous CSF Otorrhea and Temporal Bone Encephaloceles: A Systematic Review and Meta-analysis

Objective: To determine audiometric outcomes after surgery for spontaneous cerebrospinal fluid (CSF) otorrhea and temporal bone encephaloceles using different approaches and repair material.

Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for reporting of this systematic review. Pubmed was queried for studies on spontaneous CSF otorrhea and temporal bone encephaloceles. Case reports, non-English language studies, and studies with trauma or previous surgery patients were excluded. There was no limit on the years searched. Relevant data extracted included pure tone average (PTA) prior and after surgery, PTA difference, air-bone gap (ABG) prior and after surgery and the ABG difference. Primary outcome was the pooled PTA and ABG difference. A negative value for PTA and ABG difference indicates improvement after surgery. Random effects model was used for meta-analysis.

Results: Forty-three studies were identified of which only seven had audiometric data for a total of 243 patients. Patients underwent transmastoid (TM), middle cranial fossa (MCF) approach, or a combined approach. The pooled PTA difference, comparing PTA after surgery to before, from all studies was −8.91 (95% CI = −16.68 to −1.13, p = 0.025 and I-squared = 0%). The pooled ABG difference, comparing ABG after surgery to before, from all studies was −9.20 (95% CI = −15.88 to −2.52, p = 0.007 and I-squared = 0%). Two studies did subgroup analysis and looked at the TM group; pooled PTA difference was −4.26 (95% CI = −20.29 to 11.77, p = 0.60 and I-squared = 62.4%). Only one of these studies had data on ABG difference. Three studies looked at the MCF approach group; pooled PTA difference was −10.13 (95% CI = −17.84 to −2.146, p = 0.01 and I-squared = 0%) and pooled ABG difference was −8.29 (95% CI = −17.22 to 0.63, p = 0.068 and I-squared = 0%). Two studies looked at the combined approach group; pooled PTA difference was −4.59 (95% CI = −24.11 to 14.92, p = 0.64 and I-squared = 0%) and pooled ABG difference was −6.78 (95% CI = −20.54 to 6.99, p = 0.34 and I-squared = 0%).

Conclusions: Surgical treatment of spontaneous CSF otorrhea and temporal bone encephaloceles improves hearing, in addition to decreasing the risk of meningitis. It seems that MCF approach had the greatest improvement in hearing, however, there was not enough data to make a meaningful comparison between approaches in terms of hearing outcomes. Most studies on spontaneous CSF otorrhea and temporal bone encephaloceles focus on recurrence with shortage of studies on audiometric outcomes. Further studies comparing different surgical approaches and material used for repair are warranted.

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Artikel online veröffentlicht:
05. Februar 2024