--- title: "Signs in CSF Rhinorrhea | Halo Sign & Teapot Sign" description: "ENT notes on signs in CSF Rhinorrhea - Halo sign & Teapot sign." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/csf-rhinorrhea-signs-halo-sign-teapot-sign" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Rhinology"] video: "https://www.youtube.com/watch?v=3CgrtyU54n4" image: "https://media.theentresident.com/og-images/csf-rhinorrhea-signs-halo-sign-teapot-sign.png" --- # Signs in CSF Rhinorrhea | Halo Sign & Teapot Sign ENT notes on signs in CSF Rhinorrhea - Halo sign & Teapot sign. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=3CgrtyU54n4 ## Signs in CSF Rhinorrhea Two classical bedside signs are seen in **CSF rhinorrhea**. In this post, we will discuss: * Halo Sign * Teapot Sign --- ### Halo Sign #### 📌 Type of Sign 👉 Clinical Sign A **bedside test** performed in suspected **CSF leak**. #### 📌 Also Known As 👉 Double Ring Sign 👉 Target Sign #### 🔍 What is the Sign? Halo Sign refers to the appearance seen when **nasal discharge is dropped onto a filter paper**, where the discharge is a mixture of CSF and blood. A **positive sign** shows: ✅ Central dark red blood spot ✅ Peripheral outer clear ring of CSF > What is the reason behind the Halo sign seen in CSF leaks? #### 🎯 Why is it Called Halo Sign? The appearance resembles a **halo**, with a double ring, hence the names **Halo Sign**, **Double Ring Sign** and **Target Sign**. #### ⚠️ Important Points ❌ Halo Sign is indicative of CSF, but it is **not a definitive test** > What is the Gold standard test to confirm a CSF leak? > What is the most common complication of untreated CSF rhinorrhea? #### ⚠️ Important MCQ Trap Do not confuse the two Halo Signs: | Halo Sign | Type | Seen In | | --- | --- | --- | | Halo Sign on filter paper | Clinical | Suspected CSF leak | | Halo Sign on CT Scan | Radiological | Cochlear otosclerosis | --- ### Teapot Sign #### 📌 Type of Sign 👉 Clinical Sign A **bedside sign** elicited by a **change in posture**. #### 🩺 How is it Elicited? 1- The patient is asked to **sit upright** 2- The patient then **bends forward**, with the head down A **positive sign** is: ✅ Sudden gush or marked increase in clear watery nasal discharge #### 🧠 Why Does it Occur? The **sphenoid sinus ostium** lies **anterosuperior to the sinus floor**. On bending forward, CSF pooled in the sphenoid sinus **gains easy access to the ostium**, causing a sudden increase in discharge. #### 🫖 Why is it Called Teapot Sign? The sudden increase in CSF leakage on bending forward resembles **fluid pouring out of a teapot**, hence the name **Teapot Sign**. > What is the radiological investigation of choice to localize the site of the CSF leak? --- ### ⭐ High Yield Rapid Revision Table | Sign | Elicited By | Finding | Mechanism | | --- | --- | --- | --- | | Halo Sign | Dropping nasal discharge onto filter paper | Central dark red spot with an outer clear ring | CSF has lower viscosity and diffuses further than blood | | Teapot Sign | Asking the patient to bend forward | Sudden gush of clear watery nasal discharge | Pooled CSF in the sphenoid sinus gains access to the anterosuperior ostium | --- ### 🧠 Viva Pearls * Halo Sign is also known as the Double Ring Sign or Target Sign. * Halo Sign shows a central dark red blood spot with a peripheral clear ring of CSF. * Halo Sign is indicative but not definitive for CSF. * A radiological halo sign is seen in cochlear otosclerosis, and should not be confused with the filter paper halo sign. * Teapot Sign is a sudden gush of clear watery nasal discharge on bending forward. * Teapot Sign occurs because the sphenoid sinus ostium lies anterosuperior to the sinus floor. --- ## About This Note This free ENT note on Signs in CSF Rhinorrhea | Halo Sign & Teapot Sign was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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