Impact of sinus surgery on nasal discharge in chronic rhinosinusitis: A systematic review and meta-analysis.

Background: Nasal discharge is one of the cardinal symptoms of chronic rhinosinusitis, impacting over 50% of patients. For patients with symptoms refractory to standard medical therapy, endoscopic sinus surgery is an option. The objective of this study is to characterize how nasal discharge improves after surgery in patients with chronic rhinosinusitis.

Methods: The literature was searched for articles reporting nasal discharge symptom data both at baseline and after surgery. Specific symptoms of interest on the 22-item sinonasal outcome test (SNOT-22) were "need to blow nose," "runny nose," "postnasal discharge," and "thick nasal discharge." SNOT-22 scores ranged from 0 to 5 based upon severity. Visual analog scale equivalents were recorded when available.  RESULTS: A total of 16 studies (n = 7193) were included in the analysis. All four nasal discharge questions on the SNOT-22 saw significant improvement, with need to blow nose (‒1.8 [95% confidence interval, CI: ‒2.3, ‒1.2]) and runny nose (‒1.8 [95% CI: ‒1.9, ‒1.1]) seeing the largest benefit. Patients with nasal polyps saw more improvement than those without polyps. The difference between polyp and no polyp groups was significant for need to blow nose (‒1.9 vs. ‒1.0, p < 0.001) and runny nose (‒1.8 vs. ‒1.0, p < 0.0001). Patients undergoing index or revision surgery all saw significant improvement in symptoms.

Conclusion: Surgery for chronic rhinosinusitis improves nasal discharge globally, with particular benefit to need to blow nose and runny nose on the SNOT-22. Patients with nasal polyps see larger degrees of improvement compared to those without polyps. However, patients without nasal polyps also experience significant improvement in discharge.