Reply—Spontaneous Cerebrospinal Fluid Otorrhea and Rhinorrhea in Idiopathic Intracranial Hypertension Patients
We thank Vaphiades et al for their interesting comments. Our manuscript (1) describes 4 patients with idiopathic intracranial hypertension (IIH) and increased intracranial pressure (ICP) (range, 270–370 mm H2O) that developed an unusual complication of spontaneous rhinorrhea or otorrhea (one as the initial chief complaint and the others later in the clinical course). Our study does not address the issue of whether most cases of spontaneous cerebrospinal fluid (CSF) leak occur in patients with high ICP or not. In a recent publication by Chaaban et al (2), it was reported that the majority of spontaneous CSF leaks are secondary to increased ICP, and that successful treatment of elevated ICP together with endoscopic repair can provide cure for most patients. This conclusion contradicts an earlier publication by Shugar et al (3) who have reported that 55% of cases of nontraumatic rhinorrhea described in the literature are associated with normal ICP and 45% with elevated pressure. Spontaneous rhinorrhea or otorrhea is rare in patients with IIH. One goal of our report was to raise awareness among clinicians to these unusual manifestations.
1. Rosenfeld E, Dotan G, Kimchi TJ, Kesler A. Spontaneous cerebrospinal fluid otorrhea and rhinorrhea in idiopathic intracranial hypertension patients. J Neuroophthalmol. 2013;33:113–116.
2. Chaaban MR, Illing E, Riley KO, Woodworth BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope. [published ahead of print June 20, 2013] doi: 10.1002/lary.24160.
© 2013 by North American Neuro-Ophthalmology Society
3. Shugar JM, Som PM, Eisman W, Biller HF. Non-traumatic cerebrospinal fluid rhinorrhea. Laryngoscope. 1981;91:114–120.