Female Sex, Allergies Tied to Worse Postnasal Discharge in Chronic Rhinosinusitis

A study found that patients with chronic rhinosinusitis report worse postnasal discharge symptoms, particularly among people meeting specific demographics.1

“This study found that female sex, prior [endoscopic sinus surgery], CRSsNP, and diagnosis of allergies were associated with higher odds of having severe [postnasal discharge,” wrote investigators, led by Pranav A. Patel, BS, from the department of otolaryngology-head and neck surgery at the Medical University of South Carolina, in Charleston.

Nasal discharge is a fundamental symptom of chronic rhinosinusitis, evaluated with 4 questions in the 22-item Sinonasal Outcomes Test (SNOT-22). Patients often describe nasal discharge in different ways, such as the need to blow their nose, a runny nose, and a thick nasal discharge.

The symptom burden of chronic rhinosinusitis varies among age, race, and sex. For instance, research has shown that females with chronic rhinosinusitis have worse quality of life than males.2 Other factors can contribute to symptom burden, including the subtype and nasal polyp status, or other conditions such as asthma, allergy, and acid reflux, which can affect the upper airway and worsen the severity.3

Due to the variability of symptom burden in chronic rhinosinusitis, investigators aimed to determine which patient-specific factors influence the severity of nasal drainage.1 The team suspected there would be a difference in symptom severity for the “need to blow nose,” “runny nose,” “postnasal discharge,” and “thick nasal discharge” across demographic groups. They also believed symptom severity would worsen with comorbid conditions of the upper and lower airways.

This was a secondary data analysis of a prospective, longitudinal, multi-institutional study conducted at Oregon Health and Science University, the Medical University of South Carolina, Stanford University, the University of Utah, and the University of Calgary. Participants (aged ≥ 18 years) with medically refractory chronic rhinosinusitis, confirmed using current guidelines on Adult Sinusitis from the American Academy of Otolaryngology, were enrolled from 2011 to 2020.

Refractory referred to patients who were unable to reach adequate symptom control after a minimum of a 3-week course of broad-spectrum or culture-directed antibiotics, as well as a 3-week trial of topical steroid therapy. Investigators noted it was likely the participants failed standard medical therapy and frequently demonstrated more severe disease phenotypes since they were assessed at tertiary rhinology centers.

The team collected data on demographics, medical history, and SNOT-22 scores. A SNOT-22 score of ≥ 3 was considered indicative of a severe symptom. The sample included 1020 patients, evenly distributed by gender and polyp status.

Postnasal discharge emerged as the most severe symptom, with an average score of 2.98 (± 1.5). More than half of the patients (67.3%) reported a severe disease.

The analysis identified several factors significantly associated with severe postnasal discharge, including female sex (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.5 – 2.5), a diagnosis of chronic rhinosinusitis without nasal polyps (OR, 1.5; 95% CI, 1.1 – 2.0), prior endoscopic sinus surgery (OR, 1.5; 95% CI, 1.1 – 2.0), and allergies (OR, 1.4; 95% CI, 1.1 – 1.80. Acid reflux and asthma were not associated with postnasal discharge.

“This result was unexpected as there is literature demonstrating a relationship between CRS and reflux,” investigators wrote.

Investigators noted several limitations with the findings, including the cohort having a lower prevalence of acid reflux than the generation population and only including patients with medically refractory chronic rhinosinusitis, both of which may have introduced selection bias. Moreover, the study did not account for treatment status or the severity of comorbidities, which could have influenced the observed associations.

“As this was a baseline cross-sectional study, future research should focus on how these patient-specific factors impact treatment response and clinical outcomes,” investigators concluded.

References

1. Patel PA, Kallenberger EM, Nguyen SA, Mace JC, Duffy AN, Soler ZM, Smith TL, Schlosser RJ. Factors Affecting Nasal Discharge in Chronic Rhinosinusitis Patients. Laryngoscope. 2025 May 26. doi: 10.1002/lary.32288. Epub ahead of print. PMID: 40417805.

2. Asokan A, Mace JC, Rice JD, Smith TL, Soler ZM, Ramakrishnan VR. Sex Differences in Presentation and Surgical Outcomes From a Prospective Multicenter Chronic Rhinosinusitis Study. Otolaryngol Head Neck Surg. 2023;168(3):491-500. doi:10.1177/01945998221102810

3. Chaaban MR, Walsh EM, Woodworth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy. 2013;27(6):473-478. doi:10.2500/ajra.2013.27.3981