The nature of nasal discharge in chronic rhinosinusitis: a systematic review and meta-analysis using patient-reported outcomes.

Objective: The objective of this study is to answer the question "What is the most common and severe type of nasal discharge in patients with chronic rhinosinusitis (CRS) at baseline as measured by patient-reported outcomes?". Methodology: Two independent reviewers evaluated studies for inclusion, extracted data from included studies, and performed critical appraisal of studies. Data on the four Sino-Nasal Outcome Test 22 (SNOT22) discharge questions, demographic, and comorbidity data was collected. Meta-analysis of single means and proportions was performed for demographic, comorbidity, severity, and prevalence data. Results: A total of 53 studies (n = 6584) were included for analysis. Postnasal drip (PND) was the most severe symptom (2.6, 95%CI: 2.2-3) and most prevalent (80.7%, 95%CI: 53.0-97.7). Patients without nasal polyps had a higher PND score than those with polyps (2.56 vs 2.40, 95%CI: 0.1-0.2). However, patients with polyps reported higher symptom scores for need to blow nose, runny nose, and thick nasal discharge (all p < 0.0001). Conclusions: CRS patients experience PND at a higher prevalence and severity at baseline than the other three forms of nasal discharge captured by the SNOT22. Polyp status influences differing symptoms of nasal drainage. Comorbid asthma or allergies are associated with more severe PND and total SNOT22 scores.