The cause of the leak was accidental trauma in 11 patients, spontaneous in 9 patients, and iatrogenic in 5 patients. The ethmoidal roof was the most common site of leak (52%) followed by the cribriform plate (40%) and then the sphenoid sinus (8%). We have achieved 100% success rate in sealing the CSF fistulas in our 25 patients with no recurrence detected during the follow-up period (mean, 19+/-10 months). The preoperative use of fluorescein-soaked cotton pledgets was 100% accurate in diagnosing CSF rhinorrhea when compared with B2 transferrin testing. The intraoperative use of topical intranasal fluorescein was also 100% accurate in locating the site of the CSF fistula when compared with the surgical findings. No major complications have been reported.
In contrast to these findings, nebulized lidocaine is relatively ineffective and time consuming. Babl et al actually showed nebulized lidocaine to cause distress and not reduce pain associated with NGT placement in children. (In the opinion of the web site authors, the most likely cause for nebulized drugs to be ineffective when compared to nasal and buccal delivery is that most of the medication is lost into the environment and never even gets to the patient. furthermore it takes considerable time to deliver so the clinical effect is delayed.)