Factors Affecting Nasal Discharge in Chronic Rhinosinusitis Patients

Nasal discharge is a cardinal symptom of chronic rhinosinusitis (CRS); however, patients often use variable descriptions for this symptom. The 22-item Sinonasal Outcomes Test (SNOT-22) presents four different questions regarding this symptom. The objective of this cross-sectional analysis was to determine which patient-specific factors influence the severity of nasal drainage.

Demographic information, medical history, and SNOT-22 scores were recorded at baseline as part of a multi-institutional, prospective cohort study of patients with CRS refractory to medical therapy. Severe symptoms were defined as scores ≥ 3 on the SNOT-22 item response. Bivariate odds ratio (OR) calculations and multivariate regression analysis were completed.

A total of 1020 patients were included, equally split based on gender and polyp status. On the SNOT-22, postnasal discharge (PND) was the most severe discharge symptom reported, with an average score of 2.98 [SD ± 1.5] and 67.3% of patients reporting severe disease. Female sex (OR = 2.0, [95% CI: 1.5-2.5]), diagnosis of CRS without nasal polyps (OR = 1.5, [95% CI: 1.1-2.0]), prior endoscopic sinus surgery (ESS) (OR = 1.5, [95% CI: 1.1-2.0]), and allergies (OR = 1.4, [95% CI: 1.1-1.8]) were significantly associated with severe PND, while comorbid acid reflux was not (OR = 1.1, [95% CI: 0.8-1.6]; p = 0.53).

Of the various forms of nasal discharge, patients with CRS report worse symptoms related to PND. This is the first study to evaluate the effects of demographic and comorbid conditions on the presentation and severity of PND. Female sex, CRSsNP, prior ESS, and comorbid allergies are associated with higher odds of having severe PND.

3 Trial Registration: www.

gov: NCT02720653 and NCT01332136.