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Advances in the management of CSF leaks

BMJ 2001; 322 doi: (Published 20 January 2001) Cite this as: BMJ 2001;322:122

New techniques will improve the management of unilateral clear nasal discharge

  1. N S Jones (, professor in otorhinolaryngology,
  2. Daniel G Becker (, assistant professor
  1. Department of Otorhinolaryngology, University Hospital, Nottingham NG7 2UH
  2. Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA

    Important advances have been made in the diagnosis, localisation, and surgical management of cerebrospinal fluid (CSF) rhinorrhoea. CSF leaks have been associated with about a 10% risk of developing meningitis per year.1 It is important to diagnose the cause of unilateral clear rhinorrhoea and to differentiate unilateral autonomic rhinitis from the rupture of a mucus retention cyst (the contents of which are light straw coloured) or a CSF leak. CSF leaks can occur spontaneously although there may be a history of trauma or surgery. A specimen of the discharge must be sent for analysis of β 2 transferrin by immunofixation; this test has a high specificity and has superseded all other diagnostic techniques.2 The glucose oxidase test has poor predictive value and should …

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