Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2025
Re-Assessing the Interpretation of Beta Trace Protein Levels in Middle Ear Fluid in the Assessment for Lateral Skull Base Cerebrospinal Fluid Leaks.
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Pollaers Katherine, Joseph John, Lim Ee Mun, Kuthubutheen Jafri, Rodrigues Stephen
Аннотация
HYPOTHESIS: Describe the range of values of BTP obtained in middle ear fluid samples and determine if the level of BTP is a reliable indicator of the presence of a cerebrospinal fluid middle ear effusion.
BACKGROUND: Beta trace protein is a glycoprotein abundant in the CSF. Middle ear fluid samples are tested for the presence of BTP, which provides a numerical representation of the concentration of CSF. A middle ear fluid sample deemed to be positive for CSF has a BTP level of greater than 1.3 mg/L. However, this level is not specific to the middle ear, and there is a paucity of literature regarding interpretation of the BTP level when used in the evaluation for suspected lateral temporal bone CSF leaks.
METHODS: Retrospective review of all middle and nasal fluid samples sent by otolaryngologists for beta trace protein testing in Western Australia over a 4-year period.
RESULTS: A total of 168 patients had a middle ear fluid sample sent for BTP testing; these samples were obtained via tympanocentesis through an intact tympanic membrane with no other ear or temporal bone pathology. Ninety-six (96%) of the middle ear samples (172 of 178) had a BTP level greater than 1.3 mg/L, indicating a positive result and suggesting the presence of cerebrospinal fluid within the sample.
CONCLUSION: The BTP level of middle ear fluid aspirates should be viewed with caution and used in conjunction with radiological findings and clinical impressions in the formulation of a management plan in patients suspected of lateral skull base CSF leaks.
BACKGROUND: Beta trace protein is a glycoprotein abundant in the CSF. Middle ear fluid samples are tested for the presence of BTP, which provides a numerical representation of the concentration of CSF. A middle ear fluid sample deemed to be positive for CSF has a BTP level of greater than 1.3 mg/L. However, this level is not specific to the middle ear, and there is a paucity of literature regarding interpretation of the BTP level when used in the evaluation for suspected lateral temporal bone CSF leaks.
METHODS: Retrospective review of all middle and nasal fluid samples sent by otolaryngologists for beta trace protein testing in Western Australia over a 4-year period.
RESULTS: A total of 168 patients had a middle ear fluid sample sent for BTP testing; these samples were obtained via tympanocentesis through an intact tympanic membrane with no other ear or temporal bone pathology. Ninety-six (96%) of the middle ear samples (172 of 178) had a BTP level greater than 1.3 mg/L, indicating a positive result and suggesting the presence of cerebrospinal fluid within the sample.
CONCLUSION: The BTP level of middle ear fluid aspirates should be viewed with caution and used in conjunction with radiological findings and clinical impressions in the formulation of a management plan in patients suspected of lateral skull base CSF leaks.