Impact of Medical Treatment on Nasal Discharge in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

BackgroundOne of the defining symptoms of chronic rhinosinusitis is nasal discharge. There are multiple treatment options, and the relative efficacy of each medication on discharge is unclear.ObjectiveTo characterize the effects of medical treatment on the various forms of nasal discharge in chronic rhinosinusitis.Review MethodsThe literature was searched from inception through 2024 for articles reporting nasal discharge symptom data both at baseline and after treatment with medical therapy. Specific symptoms of interest on the Sino-nasal Outcomes Test 22 (SNOT-22) were "Need to Blow Nose," "Runny Nose," "Postnasal Discharge," and "Thick Nasal Discharge." SNOT-22 scores ranged from 0 to 5 based on severity. Visual Analogue Scale equivalents were recorded when available.ResultsA total of 19 studies (n = 1758) were included. All four nasal discharge questions saw statistically significant improvement, with postnasal drip and thick nasal discharge seeing the largest degree of improvement (both -1.4 [95% CI: -2.3, -0.5). Both patients with polyps (-39.2 [-49.2, -29.2]) and without nasal polyps (-26.0 [-41.9, -10.1]) saw significant improvement in rhinorrhea. Only patients with polyps saw significant improvement in postnasal discharge (PND) (-30.1 [-47.5, -12.7]). Nasal polyp patients treated with biologics saw a mean decrease of 44.1 points [95% CI: 29.9-58.3] in their total SNOT, compared with 15.9 [95% CI: 8.8-22.9] and 14.5 [95% CI: 4.1-25.0] point decreases in standard and alternative medical treatments, respectively. Both biologic and standard medical treatments led to reductions in VAS Rhinorrhea, with biologics leading to a greater reduction (P = .03). Only patients receiving biologics underwent significant improvement in VAS PND scores.ConclusionIn chronic rhinosinusitis, all 4 types of nasal discharge reported on the SNOT-22 saw significant improvement. Both patients with polyps and without polyps see improvement in discharge. Treatment of nasal polyps with biologics results in significantly greater improvement in nasal discharge compared to standard medical therapy and alternative treatments.