title: Radiographic Mastoid and Middle Ear Effusions in Intensive Care Unit Subjects.
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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania huyettpa@upmc.edu.
authors.forename: Phillip
authors.initials: P
authors.lastname: Huyett
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Veteran's Affairs Hospital Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yael
authors.initials: Y
authors.lastname: Raz
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Barry E
authors.initials: BE
authors.lastname: Hirsch
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: McCall
mesh_terms: D000367:Age Factors; D000368:Aged; D004432:Ear, Middle / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging*; D008417:Mastoiditis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Lund-Mackay score; endotracheal intubation; intensive care unit; mastoid effusion; middle ear space effusion; nasogastric intubation; nosocomial infections