J Korean Neurosurg Soc.  2020 Sep;63(5):640-648. 10.3340/jkns.2020.0067.

Relationship between Increased Intracranial Pressure and Mastoid Effusion

• Jung H
• Jang KM
• Ko MJ
• Choi HH
• Nam TK
• Kwon JT
• Park Ys

• KMID: 2506028
• DOI: http://doi.org/10.3340/jkns.2020.0067

Abstract

Objective
: This study aimed to assess the relationship between increased intracranial pressure (ICP) and mastoid effusions (ME).
Methods
: Between January 2015 and October 2018, patients who underwent intracranial surgery and had ICP monitoring catheters placed were enrolled. ICP was recorded hourly for at least 3 days. ME was determined by the emergence of opacification in mastoid air cells on follow-up brain imaging. C-reactive protein (CRP) levels, presence of endotracheal tube (ETT) and nasogastric tube (NGT), duration of intensive care unit (ICU) stay, duration of mechanical ventilator application, diagnosis, surgical modalities, and presence of sinusitis were recorded. Each factor’s effect on the occurrence of ME was analyzed by binary logistic regression analyses. To analyze the independent effects of ICP as a predictor of ME a multivariable logistic regression analysis was performed.
Results
: Total of 61 (53%) out of 115 patients had ME. Among the patients who had unilateral brain lesions, 94% of subject (43/50) revealed the ipsilateral development of ME. ME developed at a mean of 11.1±6.2 days. The variables including mean ICP, peak ICP, age, trauma, CRP, ICU stays, application of mechanical ventilators and presence of ETT and NGT showed statistically significant difference between ME groups and non-ME groups in univariate analysis. Sex and the occurrence of sinusitis did not differ between two groups. Adding the ICP variables significantly improved the prediction of ME in multivariable logistic regression analysis.
Conclusion
: While multiple factors affect ME, this study demonstrates that ICP and ME are probably related. Further studies are needed to determine the mechanistic relationship between ICP and middle ear pressure.

Keyword

Critical care; Intracranial hypertension; Intensive care units; Mastoid; Middle ear effusion.

Figure

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  Fig. 1. Magenetic resonance imaging (MRI) of diagnosis of middle ear effusion. A : Initial T2 weight brain MRI before decompressive craniectomy showing air density of the mastoid air cells. B : Three-week follow up MRI of the same patient after surgery. Opacification of bilateral mastoid air cell is noted. This 42-year old man was presented with alterered consciousness due to left middle cerebral artery infarction. Left side craniectomy was done for decompression.

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  Fig. 2. Comparison of area under the curves among continuous variables to predict mastoid effusion. ROC : receiver operating characteristic, ICP : intracranial pressure, CRP : C-reactive protein, ICU : intensive care unit, MV : mechanical ventilation.

Reference

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