{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:18:07Z","timestamp":1781619487638,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,11,17]],"date-time":"2016-11-17T00:00:00Z","timestamp":1479340800000},"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":[[2017,3]]},"abstract":"<jats:sec><jats:title>Outcome Objectives<\/jats:title><jats:p>To (1) identify unique features of patients who underwent middle ear\/mastoid obliteration with blind\u2010sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case series with chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2\u00a0groups based on the surgery performed: (1) 11 patients underwent middle ear\/mastoid obliteration with blind\u2010sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre\u2010 and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9\u00a0kg\/m2; <jats:italic>P<\/jats:italic> &lt;. 05), incidence of super\u2010morbid obesity (45% vs 7.6%; <jats:italic>P<\/jats:italic> =. 015), anticoagulation usage (36% vs 0%; <jats:italic>P<\/jats:italic> =. 004), cardiac risk scores (1.2 vs 0.1\u00a0dB; <jats:italic>P<\/jats:italic> &lt;. 0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow\u2010up was 30.8 \u00b1 8.6\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Middle ear and mastoid obliteration with blind\u2010sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599816678211","type":"journal-article","created":{"date-parts":[[2016,11,16]],"date-time":"2016-11-16T09:19:37Z","timestamp":1479287977000},"page":"534-542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Middle Ear Obliteration with Blind\u2010Sac Closure of the External Auditory Canal for Spontaneous CSF Otorrhea"],"prefix":"10.1002","volume":"156","author":[{"given":"Shawn M.","family":"Stevens","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati Cincinnati Ohio USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Crane","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati Cincinnati Ohio USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myles L.","family":"Pensak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati Cincinnati Ohio USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi N.","family":"Samy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati Cincinnati Ohio USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,11,17]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Centers for Disease Control and Prevention (CDC). Obesity prevalence maps(2013).http:\/\/www.cdc.gov\/obesity\/data\/prevalence\u2010maps.html. Accessed August 13 2016."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000535"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.9.1655"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.49.2.507"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814557470"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816630738"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816651261"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000552"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2014.28.4002"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813518173"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.6.JNS13322"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20510"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1058181"},{"key":"e_1_2_9_15_1","first-page":"198","article-title":"Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management","volume":"18","author":"Jackson CG","year":"1997","journal-title":"Am J Otol"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.2000.00383.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.134.5.509"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.11.036"},{"key":"e_1_2_9_19_1","first-page":"461","article-title":"Temporal bone encephalocele and cerebrospinal fluid leaks","volume":"17","author":"Lundy LB","year":"1996","journal-title":"Am J Otol"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e318157f7b6"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.moo.0000179247.51476.f5"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2014.06.010"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130508401110"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215108001990"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(89)90496-7"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.09.001"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197710202971601"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.100.10.1043"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000702"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mao.0000265187.45216.71"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1058571"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004050050037"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100145499"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2002.129822"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e318289841b"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-013-2698-3"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000337"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31815dbb40"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940711600914"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mao.0000178119.46290.e1"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000165455.20118.E3"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348947608500301"},{"key":"e_1_2_9_43_1","first-page":"551","article-title":"Mastoidectomy elimination: obliterate, reconstruct, or ablate?","volume":"19","author":"Black B.","year":"1998","journal-title":"Am J Otol"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2005.02.023"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2249.2003.02190.x"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00109-003-0492-1"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816678211","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599816678211","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816678211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:26:17Z","timestamp":1760952377000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599816678211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,17]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1177\/0194599816678211"],"URL":"https:\/\/doi.org\/10.1177\/0194599816678211","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,17]]},"assertion":[{"value":"2016-08-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-11-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}