Imagine one day you notice a clear, watery fluid dripping from one nostril — especially when you lean forward or blow your nose. You may think it’s just an allergy or a runny nose — but what if it isn’t? What if that fluid is actually your brain fluid leaking?
This condition is called cerebrospinal fluid (CSF) rhinorrhea. It’s rare, but important to know about — because untreated, it can lead to serious complications. Let’s understand it in simple terms.
What Is CSF and What Is Rhinorrhea?
– Cerebrospinal fluid (CSF) is a clear fluid that surrounds your brain and spinal cord. It cushions and protects them.
– Rhinorrhea means nasal discharge or “runny nose”.
– CSF rhinorrhea happens when CSF leaks into the nose through a small defect in the skull base, allowing brain fluid to escape.
What Causes It?
There are two main groups of causes:
-
Traumatic Causes
– Head injury (road traffic accident, fall & fracture)
– After sinus or brain surgery -
Spontaneous Causes
– High pressure inside the skull (raised intracranial pressure)
– Natural thinning or weakness of the skull base
– Tumours or infections eroding the bone
How Does It Present?
Common symptoms include:
– Clear, watery nasal discharge (usually one-sided)
– Leak increases when bending down, straining, or coughing
– Salty taste at the back of the throat
– Headache that worsens when upright
– Repeated episodes of meningitis (infection of the brain coverings)
How Doctors Diagnose It?
Your ENT specialist will recommend:
– Clinical examination and symptom history
– Testing the nasal fluid for a special protein called β2-transferrin – unique to CSF
– CT/MRI scans to pinpoint the leak site
– Occasionally, CT cisternography is used to map the exact path of leakage
Treatment Options
Treatment depends on cause and severity:
– Conservative management for small leaks:
- Bed rest, head elevation, no straining or nose blowing
- Control of intracranial pressure
– Surgical repair for persistent leaks:
- Endoscopic nasal surgery (minimally invasive, high success rate)
- Rarely, open skull surgery if required
The Take-Home Message
CSF rhinorrhea may look like a simple runny nose — but it’s a sign of a deeper issue. Recognising it early protects you from serious infections and brain complications.
If you notice a persistent, clear nasal drip from one side, especially after a head injury or surgery, see an ENT specialist immediately.
Modern scans and surgical techniques offer safe and permanent repair. Early detection saves lives.
Your nose could be whispering what your brain wants you to know — don’t ignore it!
Dr. Kingston S.
Consultant ENT & Head-Neck Surgeon,
Kauvery Hospital, Chennai
