Cerebrospinal fluid in the rhinitis clinic.

The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were diagnosed. In each case long term topical steroid sprays had been prescribed and the patients had been referred for further management of their 'rhinitis'. Spontaneous CSF rhinorrhoea is potentially life threatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the fistula is employed. Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.