{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:31:55Z","timestamp":1776792715106,"version":"3.51.2"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The clinical significance of mastoid effusion (ME) in intensive care unit (ICU) patients has not been well elucidated. Recently, an association between ME and intracranial pressure (ICP) has been reported. We aimed to investigate the clinical implications of ME occurrence in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients and its association with their prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from patients aged &amp;gt; 18\u202fyears who were treated for aSAH in a single institution between January 2020 and December 2022 were retrospectively reviewed. Brain CT or MRI images obtained within the first 14\u202fdays after the onset of SAH were evaluated for the presence of ME, which is defined as either opacification or an air-fluid level in the mastoid air cells. We examined the patients\u2019 demographic information, neurological and medical status at admission, aneurysm and treatment characteristics, and clinical outcomes. We then analyzed how these factors were associated with the occurrence of ME.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 114 patients were included in the study. ME was observed in 40 patients (34.5%) within the first 14\u202fdays, occurring at a mean of 5.0\u202f\u00b1\u202f3.5\u202fdays after the onset of SAH. In multivariate analysis, patients with ME were found to have a higher incidence of tracheostomy (odds ratio [OR] 10.034, <jats:italic>p<\/jats:italic>\u202f=\u202f0.024), radiologic vasospasm (OR 4.987, <jats:italic>p<\/jats:italic>\u202f=\u202f0.018), a higher APACHE II score (OR 1.138, <jats:italic>p<\/jats:italic>\u202f=\u202f0.013), and poor clinical outcomes (OR 4.289, <jats:italic>p<\/jats:italic>\u202f=\u202f0.041), defined as modified Rankin Scale score &amp;gt; 2 at 90\u202fdays. Poor clinical outcomes were independently associated with ME (OR 5.003, <jats:italic>p<\/jats:italic>\u202f=\u202f0.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated that ME was observed in 34.5% of aSAH patients and was associated with poor clinical outcomes. ME may serve as a simple and useful prognostic indicator for predicting poor outcomes in aSAH patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1603869","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T15:15:53Z","timestamp":1754493353000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical implications and prognostic value of mastoid effusion in the management of aneurysmal subarachnoid hemorrhage"],"prefix":"10.3389","volume":"16","author":[{"given":"Junhyung","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Ki","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Jin","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keun Young","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Jae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong Bae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiwoong","family":"Oh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"Suppl 11:27","DOI":"10.1177\/0003489474083s1103","article-title":"Mechanics of the Eustachian tube as it influences susceptibility to and persistence of middle ear effusions in 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Pena","year":"2013","journal-title":"Respir Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.amjoto.2005.07.021","article-title":"Middle ear effusion in intensive care unit patients with prolonged endotracheal intubation","volume":"27","author":"Lin","year":"2006","journal-title":"Am J Otolaryngol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s00381-013-2036-5","article-title":"The tympanic membrane displacement analyser for monitoring intracranial pressure in children","volume":"29","author":"Gwer","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"15776","DOI":"10.1038\/s41598-018-34083-6","article-title":"Utility of the tympanic membrane pressure waveform for non-invasive estimation of the intracranial pressure waveform","volume":"8","author":"Evensen","year":"2018","journal-title":"Sci Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"640","DOI":"10.3340\/jkns.2020.0067","article-title":"Relationship between increased intracranial pressure and mastoid effusion","volume":"63","author":"Jung","year":"2020","journal-title":"J Korean Neurosurg Soc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1007\/s00134-014-3483-5","article-title":"Understanding the disease: aneurysmal subarachnoid hemorrhage","volume":"40","author":"Macdonald","year":"2014","journal-title":"Intensive Care Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1056\/NEJMra052732","article-title":"Aneurysmal subarachnoid hemorrhage","volume":"354","author":"Suarez","year":"2006","journal-title":"N Engl J Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2464","DOI":"10.1161\/STROKEAHA.115.010219","article-title":"High-resolution intracranial pressure burden and outcome in subarachnoid 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consequence?","volume":"33","author":"Fink","year":"2002","journal-title":"Stroke"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.wneu.2015.08.052","article-title":"Risk factors for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a review of the literature","volume":"85","author":"Inagawa","year":"2016","journal-title":"World Neurosurg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"710-5","DOI":"10.2176\/nmc.38.710","article-title":"Relationship between intracranial pressure and the development of vasospasm after aneurysmal subarachnoid hemorrhage","volume":"38","author":"Fukuhara","year":"1998","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/978-3-7091-6475-4_62","article-title":"Intracranial pressure, cerebral perfusion pressure, and SPECT in the management of patients with SAH hunt and Hess grades I-II","volume":"71","author":"Gambardella","year":"1998","journal-title":"Acta Neurochir Suppl"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"408","DOI":"10.3171\/jns.2004.101.3.0408","article-title":"Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage","volume":"101","author":"Heuer","year":"2004","journal-title":"J Neurosurg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1179\/174313209X393564","article-title":"Cerebral vasospasm following subarachnoid hemorrhage: time for a new world of thought","volume":"31","author":"Pluta","year":"2009","journal-title":"Neurol Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1227\/01.NEU.0000222819.18834.33","article-title":"Cohen W (dynamic perfusion computed tomography in the diagnosis of cerebral 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