Does Beta-2-Transferrin Testing Affect Decision Making in Patients with CSF Otorrhea?

Introduction: Beta-2-transferrin (B2T) in an extremely specific and sensitive test often ordered when there is concern for patients with cerebrospinal fluid (CSF) otorrhea. The goal is to determine if this expensive test affects interventions implemented for these patients.

Methods: A retrospective chart review was performed of all patients from 2000-2024 who presented to UC Davis Medical Center who were diagnosed with CSF otorrhea and had a B2T test ordered. Data was collected on patient demographics (age and sex), the etiology of the CSF leak, and the location of presentation (inpatient, emergency department, or clinic). It was determined if and when interventions such as skull base precautions, lumbar drain placement, and surgery were implemented. Complications of CSF leak including meningitis, seizures, hearing loss, recurrence of leak, readmission, and death were analyzed.

Results: Twenty-nine patients (19 males, 65.5%) with CSF otorrhea met inclusion and exclusion criteria. The etiologies of CSF otorrhea were traumatic (20 patients, 68.9%), spontaneous (five patients, 17.2%) and post-operative (four patients, 13.8%). On average B2T results returned in 6 days.
In the cohort, skull base precautions were implemented an average of -7.3 days (p <.05) from B2T result. Eleven out of 29 patients (37.9%) had a lumbar drain (LD) placed and the average time from B2T result to LD placement was -3.46 days (p <.05), with 8 out of 11 (72.7%) of these occurring before B2T resulted. Surgical intervention was performed in 12 out of 29 patients (41.3%), and the average time from B2T results to surgery was 11.22 days (median 4.11 days), with 4 out of 12 (33%) occurring before B2T resulted (P=.11). There was no statistically significant difference when comparing timing of interventions between traumatic, spontaneous, and post-operative causes of CSF otorrhea (P>.15).

Conclusions: The data shows that B2T testing has no impact on clinical decision-making for CSF otorrhea treatment regarding implementation of skull base precautions and lumbar drain placement. However, B2T testing may affect decision making for surgical intervention.