xRead - September 2022

International consensus statement

TABLE 1. History and clinical examination # Statement Mode Median Range (%) 1 CSF rhinorrhea should be suspected in patients with unilateral watery rhinorrhea 7 7 5–7 12 82 2 CSF rhinorrhea should be suspected when rhinorrhea is triggered by changes in posture 6 6 5–7 47 47 3 CSF rhinorrhea should be suspected when rhinorrhea is triggered by head trauma or skull-base surgery 7 7 6–7 12 88 History taking in patients with spontaneous CSF rhinorrhea should include symptoms of IIH such as: 4 Presence of headache 7 7 4–7 29 53 5 Presence of visual defects 7 7 2–7 41 47 6 Presence of pulsatile tinnitus 7 7 3–7 38 50 7 6 4–7 41 41 Agree (%) Strongly agree

7 Patients with an active CSF leak may also present with symptoms of decreased ICP including orthostatic headache and neck stiffness. 8 Patients with spontaneous CSF leak/ IHH are usually overweight (BMI > 25) and often obsese (BMI > 30) 6 6 2–7 59 30 9 All patients with spontaneous CSF rhinorrhea should undergo a complete ENT examination including nasal endoscopy 7 7 6–7 6 94 10 Clinical examination of someone suspected of having CSF rhinorrhea should include otologic exam (fluid in the middle ear could indicate an otologic source for the CSF leak) 7 7 6–7 24 76 11 Examination of the Eustachian tube by endoscopy can be valuable when examining for an otologic source for CSF rhinorrhea 7 6 4–7 35 47 12 In patients with spontaneous CSF leak ophthalmologic assessment including fundoscopy for papilledema and assessment of visual fields is suggested 7 7 6–7 24 76 BMI = body mass index; CSF = cerebrospinal fluid; CT = computed tomography; ENT = ear, nose, throat; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension.

International Forum of Allergy & Rhinology Vol No April

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