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BACKGROUND: This study was conducted to determine the incidence of and risk factors associated with the development of radiographic mastoid and middle ear effusions (ME/MEE) in ICU patients.
METHODS: Head computed tomography or magnetic resonance images of 300 subjects admitted to the University of Pittsburgh Medical Center neurologic ICU from April 2013 through April 2014 were retrospectively reviewed. Images were reviewed for absent, partial, or complete opacification of the mastoid air cells and middle ear space. Exclusion criteria were temporal bone or facial fractures, transmastoid surgery, prior sinus or skull base surgery, history of sinonasal malignancy, ICU admission < 3 days or inadequate imaging.
RESULTS: At the time of admission, 3.7% of subjects had radiographic evidence of ME/MEE; 10.3% (n = 31) of subjects subsequently developed new or worsening ME/MEE during their ICU stay. ME/MEE was a late finding and was found to be most prevalent in subjects with a prolonged stay (P < .001). Variables associated with ME/MEE included younger age, the use of antibiotics, and development of radiographic sinus opacification. The proportion of subjects with ME/MEE was significantly higher in the presence of an endotracheal tube (22.7% vs 0.6%, P < .001) or a nasogastric tube (21.4% vs 0.6%, P < .001).
CONCLUSIONS: Radiographic ME/MEE was identified in 10.3% of ICU subjects and should be considered especially in patients with prolonged stay, presence of an endotracheal tube or nasogastric tube, and concomitant sinusitis. ME/MEE is a potential source of fever and sensory impairment that may contribute to delirium and perceived depressed consciousness in ICU patients.
- nosocomial infections
- mastoid effusion
- middle ear space effusion
- intensive care unit
- endotracheal intubation
- nasogastric intubation
- Lund-Mackay score
- Correspondence: Phillip Huyett, MD, University of Pittsburgh Medical Center, Department of Otolaryngology-Head & Neck Surgery, 200 Lothrop St, Suite 500, Pittsburgh, PA 15213. E-mail:
Dr Huyett presented a version of this paper at the Triological Society at the Combined Otolaryngology Sections Meeting held May 21, 2016, in Chicago, Illinois.
The authors have disclosed no conflicts of interest.
The statistical analysis performed in this project was supported by the National Institutes of Health through Grant Number UL1TR000005.
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