{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T22:13:19Z","timestamp":1778451199210,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the prevalence, postsurgical recurrence, and risk factors associated with spontaneous cerebrospinal fluid (sCSF) otorrhea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>PubMed, Embase, Web of Science, and ScienceDirect were systematically searched for studies from inception to November 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Random effect model meta\u2010analysis was performed to estimate the pooled effect sizes of geographical prevalence, recurrence rates, and risk factors associated with sCSF otorrhea. We also performed a sensitivity analysis, metaregression, and publication bias assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 24 out of 466 studies were included and comprised 1059 patients with cerebrospinal fluid (CSF) otorrhea. The prevalence rate of sCSF otorrhea among all CSF otorrhea patients was estimated at 37.8% (95% CI: 23.9%\u201054.1%). Geographically, the prevalence of sCSF otorrhea was higher in North America than in Europe (46.5% vs 16.8%), whereas recurrence rates were similar (10.7% vs 10.6%). The postsurgical recurrence rate of sCSF otorrhea was 10.3% (95% CI: 7.5%\u201013.8%). The most prevalent risk factors were obesity (73.9%, 95% CI: 63.9%\u201081.9%), hypertension (63.4%, 95% CI: 54.2%\u201071.7%), empty sella (49.3%, 95% CI: 38.5%\u201060.2%), and obstructive sleep apnea (OSA) (37.6%, 95% CI: 24.0%\u201053.5%). On metaregression, both OSA (\u22120.09, <jats:italic>P<\/jats:italic>\u2009=\u2009.03) and prior history of meningitis (\u22120.05, <jats:italic>P<\/jats:italic>\u2009=\u2009.004) were negatively associated with male gender. This indicates a greater association between risk factors for sCSF otorrhea and the female gender.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This meta\u2010analysis is the first to estimate the prevalence and postsurgical recurrence of spontaneous CSF otorrhea. This study also highlights the prevalent risk factors associated with sCSF otorrhea.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1314","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T09:51:06Z","timestamp":1749721866000},"page":"797-811","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Global Prevalence, Recurrence, and Risk Factors Associated With Spontaneous CSF Otorrhea\u2014A Meta\u2010analysis"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6998-1658","authenticated-orcid":false,"given":"Srivatsa Surya","family":"Vasudevan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Louisiana State University Health Sciences Center Shreveport Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Albornoz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Louisiana State University Health Sciences Center Shreveport Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney","family":"Schwab","sequence":"additional","affiliation":[{"name":"Louisiana State University Health School of Medicine Shreveport Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6993-6622","authenticated-orcid":false,"given":"Gauri","family":"Mankekar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Louisiana State University Health Sciences Center Shreveport Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25461"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200405000-00002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","DOI":"10.1177\/01455613231201021","article-title":"Analysis of 3 surgical approaches for the treatment of cerebrospinal fluid otorrhea: a case series report","volume":"30","author":"Sun S","year":"2023","journal-title":"Ear Nose Throat J"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1697976"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_7_1","unstructured":"WellsG SheaB O'ConnellD et al. 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