Radiographic Mastoid and Middle Ear Effusions in Intensive Care Unit Subjects

Phillip Huyett, Yael Raz, Barry E. Hirsch, Andrew A. McCall

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)350-356
Number of pages7
JournalRespiratory Care
Volume62
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Otitis Media with Effusion
Mastoid
Intensive Care Units
Delirium
Temporal Bone
Sinusitis
Skull Base
Middle Ear
Consciousness
Nervous System
Fever
Magnetic Resonance Spectroscopy
Air
Head
Tomography
Anti-Bacterial Agents
Incidence
Neoplasms

Keywords

  • endotracheal intubation
  • intensive care unit
  • Lund-Mackay score
  • mastoid effusion
  • middle ear space effusion
  • nasogastric intubation
  • nosocomial infections

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Radiographic Mastoid and Middle Ear Effusions in Intensive Care Unit Subjects. / Huyett, Phillip; Raz, Yael; Hirsch, Barry E.; McCall, Andrew A.

In: Respiratory Care, Vol. 62, No. 3, 01.03.2017, p. 350-356.

Research output: Contribution to journalArticle

Huyett, Phillip ; Raz, Yael ; Hirsch, Barry E. ; McCall, Andrew A. / Radiographic Mastoid and Middle Ear Effusions in Intensive Care Unit Subjects. In: Respiratory Care. 2017 ; Vol. 62, No. 3. pp. 350-356.
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abstract = "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.",
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N2 - 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.

AB - 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.

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KW - middle ear space effusion

KW - nasogastric intubation

KW - nosocomial infections

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