Rarely the collection of a nasal swab or the placement of nasal packing material can result in a cerebrospinal fluid (CSF) leak.

Risk factors for an iatrogenic CSF leak:

(1) history of prior skull base defects including encephalocele

(2) history of sinus or skull base surgery

(3) conditions associated with skull base erosion

(4) use of a rigid swab (versus flexible swab) or instrument

(5) excessive force applied

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