Intracranial otogenic complications in adults: new factors that influenced its onset, frequency and nature

The two cohorts were designed for the purpose of the retrospective analysis. The therapeutic activity of the Department of Otolaryngology at Poznan University of Medical Sciences in two time periods was compared: January 2019–February 2020 and March 2020–April 2021. In the first period, 1434 otological outpatient visits, 509 planned otosurgeries, and 17 urgent otological procedures were performed. In the second period, these were 1150, 566 and, 20 respectively. There were 14 intracranial complications, 5 in the pre-COVID and 9 in the COVID cohort, including 1 and 5 sigmoid sinus thrombosis, respectively.

For the purpose of the study we also analyzed the frequency of intracranial otogenic complications in our hospital in the preceding 5 years. As shown in Table 1. The percentage of CVST in total number of intracranial complications exceeded 40% only once before 2020 and there is no noticeable trend in frequency of complications within those years.

Table 1 Incidence of intracranial otogenic complications in time with a special regard to CVST

Planned otosurgeries were defined as tympanoplasty (including cholesteatoma surgeries), stapes surgery, cochlear implants and osseous implants. Urgent otosurgery and inclusion criteria for the otogenic complications group were defined as subacute or chronic otitis media with ear discharge exacerbation, headache, otalgia, and fever at presentation, established diagnosis of intra-temporal (labyrinthitis, facial nerve paresis, mastoiditis) or intracranial complications (meningitis, epidural/subdural/brain abscess, sigmoid sinus/internal jugular vein thrombosis). The time from registration in the emergency room to performing the surgery (antromastoidectomy, wall-up/down technique, abscess drainage, internal jugular vein ligation) ranged from 6 to 24 h; average 14 h, median 10 h. The surgeries were performed by two experienced otosurgeons (MW, WS).

Reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 of a nasopharyngeal swab was performed at the emergency department before admission to the ward. IgG antibodies tests for SARS-CoV-2 were performed between the second and fifth day of the hospital stay.

The patients’ data included otological history, character and duration of complaints, comorbidities, neurological status, information on pharmacological prophylaxis, the status of immobility and other risk factors of coagulopathy.

There were no other significant epidemiological factors such as a change in the population size, catchment area, access to health services provided by the hospital or surrounding hospitals, number of patients’ requiring admission to tertiary hospital instead of local one or a change in medical practice.

Relevant laboratory results include white cell count (WBC), platelets (PLT), prothrombin time (PT), activated partial thromboplastin time (aPTT), C-reactive protein (CRP), D-dimer, fibrinogen, and lactic acid dehydrogenase (LDH).

The radiologic diagnosis of CVST was confirmed using the following criteria: (a) Magnetic Resonance Imaging (MRI)/ Magnetic Resonance Venogram (MRV): absence of flow-related signal, (b) T1 weighted sequence with intravenous contrast agent (VIBE, MPRANGE) to confirm the presence of thrombus. In each patient, MRI was performed by 3 T Somatom Skyra Siemens and the structures of the neck were assessed by ultrasonography (Canon APLIO a-series device), with particular attention to the patency of the jugular vein.

The “pre-COVID-19” and “COVID-19” patients with intracranial otogenic complications were compared. The following variables were analysed for both cohorts: age, gender, precise diagnosis of otogenic intracranial complication (meningitis, epidural/subdural/brain abscess, sigmoid sinus/internal jugular vein thrombosis), prior history of ear disease, diagnostic imaging findings and comorbidities classified as cardiovascular, pulmonary, other, and none. The differences in the presented variables for both pre-COVID-19 and COVID-19 cohorts were analysed.

The first outcome measure was the incidence proportion of CVST and intracranial complications of otogenic origin in relation to planned otosurgical procedures or urgent otosurgical procedures in a given time. Secondary outcome measures included the incidence proportions of CVST and intracranial complications in relation to the total number of both emergency and planned outpatient consultations and the total number of planned surgical procedures in both time periods. Both cohorts were analysed for their specificity. The occurrence or absence of CVST among all intracranial complications was also analysed separately.

The incidence proportion was defined as new cases of a disease occurring in a given observation period.

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For the statistical analysis, the STATISTICA 13.1 software (Dell, U.S.A) was utilised. Nominal variables were compared between the groups in contingency tables using Fisher’s exact test; in cases where a particular cell count was null, the Haldane-Anscombe correction was applied. For 2 × 3 and 2 × 4 tables, the Freeman-Halton extension to the Fisher’s exact test was utilised. Continuous variables distribution was checked for normality using the Shapiro–Wilk test. All continuous variables were non-normally distributed, therefore the Mann–Whitney U test for non-parametric data was used to compare the groups. Where possible, the Odds Ratio with a 95% confidence interval was calculated. The alpha for all statistical tests was set at 0.05.

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