Relationship Between Obesity, Obstructive Sleep Apnea, and Spontaneous Cerebrospinal Fluid Otorrhea

Abstract

In this series, patients with spontaneous CSF otorrhea were more likely to be severely and morbidly obese than were patients with nonspontaneous otorrhea. OSA was also more common in these patients. The findings from this study support an association between obesity and spontaneous CSF leaks. Patients presenting with spontaneous CSF otorrhea should therefore be screened for OSA and signs of increased intracranial pressure.

Spontaneous Cerebrospinal Fluid Leak through the Posterior Aspect of the Petrous Bone

“…Of the 12 PF cases, 58% were female compared with the 60 to 90% incidence reported in published MF leak cases. 1,3,[5][6][7][8]10 Interestingly, only 5 of the 12 cases fell in the characteristic age range of 40 to 60 years, however the average age was still 59. Not enough information was available with regards to obesity and IIH.…”

“…A disproportionate number of patients with middle fossa (MF) leaks are female, aged 40 to 60 with a body mass index (BMI) greater than 30. [3][4][5][6][7][8] Patients typically present with conductive hearing loss, aural fullness, and cerebrospinal otorrhea. 1,6,9,10 Due to the rarity of PF leaks, the demographics and clinical presentation are less well defined.…”

“…The MF is more prone to dehiscence and CSF leak due to a combination of a thinner bony plate and a higher proportion of AGs compared with the posterior petrous face. [11][12][13] Recently in the last 5 to 10 years, associations between temporal bone CSF leak, obesity, [6][7][8]14,15 and idiopathic intracranial hypertension (IIH) 3,5,6,[14][15][16] have been noted. IIH interestingly shares the similar demographics of age 40 to 60, female gender, and BMI greater than 30.…”

Association Between Obstructive Sleep Apnea and Spontaneous Cerebrospinal Fluid Leaks

“…Fleischman et al 11 demonstrated that the odds of having OSA and spontaneous CSF rhinorrhea were 2.57 times (P = .04) more likely than the odds of having OSA and nonspontaneous CSF leaks. The association of OSA and spontaneous CSF otorrhea reported by Levay and Kveton 6 was not significant.…”

“…There was no difference in the skull thickness of patients with a spontaneous CSF leak and OSA compared with those with a spontaneous CSF leak without OSA. Fleischman et al 11 Nelson et al 8 Three published studies were included in the analysis: LeVay and Kveton, 6 Nelson et al, 8 and Fleischman et al 11 OR indicates odds ratio of bias; SE, standard error …”