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Diagnosis and Management of Otologic Cerebrospinal Fluid Leak

      Cerebrospinal fluid (CSF) leakage is a rare but potentially life-threatening condition that requires thorough and timely intervention. It occurs when the barriers retaining CSF around the brain are breached. Otorrhea occurs only when there is violation of these barriers within the temporal bone. Thus, there is breach of the arachnoid membrane, dura mater, bone, and mucosal lining of the mastoid and middle ear. To complete the route of egress there must be a defect in the external auditory canal or perforation of the tympanic membrane. If this defect is not present, CSF, once in the middle ear cleft, can flow down the eustachian tube and present as otorhinorrhea. A physician therefore must remember that rhinorrhea does not always come from the anterior skull base and must be vigilant for an otologic cause.
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