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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Smoker, over weight, runny nose with high blood pressure. Any ideas?

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ENT Specialist
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almost everyday when i bend over i have a clear like water fluid run out my nose. i'm 59, smoke, over weight and have high blood pressure. any ideas
Wed, 9 Jan 2013 in General Health
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query,

1. The possible causes are allergy, sinusitis or a CSF leak. Is this one sided or both sides?

2. Do you have any allergic symptoms such as sneezing, nasal obstruction or itching in the nose, palate or eyes?

3. What you describe resembles the 'Teapot' or Reservoir' Sign i.e. Clear nasal discharge on bending forwards.

4. You should get the fluid collected in a sterile container and tested to rule out CSF. Get a Beta-2 Transferrin test on the fluid, if available.

5. A simple test is the 'Handerchief Test': Normal nasal secretions contain mucus which will stain and stiffen a soft handkerchief on drying, but CSF will not.

6. If CSF leak is suspected, a CT cisternography and MRI with contrast should be done. Spontaneous leaks may be multiple.

7. If you have confirmed CSF rhinorrhea, then an endoscopic repair through the nose or an open approach (craniotomy) will be possible with fat, cartilage, fascia and fibrin glue.

8. If it is not CSF, Nasal steroid sprays, anti allergic medication and regular steam inhalation will help control these symptoms.

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