Hello

Thanks for writing to H.C.M. for your query.

I have gone through your query regarding vertigo which you are having for last 18 months.I have review your recent developments as regular vertigo attacks, headache, ear pain and blood stained discharge from affected ear and salty clear fluid comming out from nostril. All these features indicates that your previous diagnosis BPVV should be revise and now it appears to be of intracranial origin.

Since you are feeling increase pressure in your head and clinically from complaints clear fluid comming from nostril appears to be CSF.Your nystagmus are also more or less continuous therefore you are advice for these investigations-

(a) Cytological & Biochemical examination of fluid comming from nostril.

(b) M.R.I.of head to rule out pathology of C.P.angle and cerebrum.

(c) Fundus examination by ophthalmologist.

(d) Complete nurological examination to rule out signs of raised intracranial tension.

By approaching in this way one can reach to correct diagnosis and plan for further treatment.

Wishing for your speedy recovery.

Regards.

---

Hello

Thanks for writing back to me for clarification of said reply.

I would like to tell you there are two common diseases of nose were clear watery fluid comes out of nostril-
(a) Allergic Rhinitis.
(b) CSF Rhinorrhea.
To differentiate above two situation it is necessary to find out the cyto-chemical constituent of the fluid which is comminig out. Therefore the desired test in fluid is to estimate- Chloride, sugar, protein, bicarbonate and different cells as polymorphs, lymphocytes, esinophils and monocytes etc.

Regards.

---