Evidence suggests that patients with inflammatory bowel disease are at higher risk of developing nonalcoholic fatty liver disease (NAFLD). However, there is limited information currently available on how NAFLD may affect the clinical course of IBD. Thus, we conducted a systematic review to evaluate the impact of NAFLD on IBD-related hospitalization outcomes. All observational studies assessing IBD-related hospitalization outcomes in patients with NAFLD were included. Exclusion criteria were studies published in languages other than English or French, or those involving pediatric population. Outcomes included IBD-related hospitalization and readmission rates, need for surgery, length of stay, inpatient mortality, and costs. Overall, 3252 citations were retrieved and seven studies met the inclusion criteria (1 574 937 patients); all were observational, of high quality, and originated in the United States. Measurable outcomes reported in these studies were few and with insufficient similarity across studies to complete a quantitative assessment. Only one study reports NAFLD severity. Two studies suggested a higher rate of hospitalization for patients with both NAFLD and IBD compared to IBD alone (incidence rate ratio of 1.54; 95% confidence interval: 1.33–1.79). This is the first systematic review to date that evaluates any possible association of NAFLD with IBD-related hospitalization outcomes. Despite the paucity and low quality of available data, our findings indicate that NAFLD may be associated with worse outcomes amongst IBD patients (especially Crohn’s disease). Further and higher certainty of evidence is needed for better characterization of such clinical impact.

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54-year-old male presented to the clinic with leftsided hearing loss that has been going on for a year and a half. He was treated with steroid injections, but never regained his previous hearing function.Recently, he developed a left jaw swelling, as well as facial numbness and twitching. He denied any history of tinnitus, vertigo, ear infection, or surgery. He started using hearing aids in the past four months. On examination, the patient had a grade 2/6 facial function. There is a parotid area mass present on the left. The remainder of the head and neck exam is normal. His left ear exam is seen in Figure 1.

A 30-year-old man presented with occasional rightsided ear pain and headaches. His history is notable for a right canal wall down (CWD) mastoidectomy and for an unknown mastoid mass in 2011. The patient was lost to follow-up for many years. In September 2021, he was treated for an ear infection with ciprofloxacin and ofloxacin. The patient denies any other otologic symptoms. On examination, there was a CWD cavity filled with debris, which was cleaned. There was a smooth, fluid-filled, compressible skin-covered pulsatile mass located anterosuperiorly in the lateral external auditory meatus, which is shown in Figure 1.