The first challenge when dealing with nasal discharge is to gain a clear understanding of the patient’s actual symptoms. Since diagnosis normally relies on accurate history, it is best to use the words or terms that the patient recognises as part of what they actually experience.

In practice, a patient who is asked whether or not they have a nasal discharge often returns a blank or quizzical look. The use of descriptive terms and questions in a short conversation is therefore usually much more effective in eliciting the desired response. Patients should be asked whether their nose runs, drips or whether their nose is ‘snotty’ or if they need to sniff or blow their nose excessively. They should also be asked about mucus dripping into the throat, and whether they can cough or spit this out.

Once the history of discharge is established, the nature of the discharge can be explored. Key factors include the tenacity, colour, persistence and variation. Nasal discharge from the nostrils is termed anterior in contrast to mucus passing into the throat, which is termed posterior discharge.

Nasal discharge is a normal occurrence with head colds and usually this takes about 3 weeks to clear. The normal nose will also run temporarily in extreme cold conditions or when exposed to irritants.

Young children do not naturally blow their noses and their nasal airway is anatomically compromised. Nasal discharge is therefore a common and normal finding.

Excess mucus may be produced without any obvious underlying cause and patients may describe this as “catarrah”. Discoloured or green-yellow mucus is consistent with chronic rhinosinusitis, but mucus that is not cleared quickly from the nose will become discoloured, particularly in the early morning after sleep.

The ‘postnasal’ drip

This term refers to the sensation of mucus at the back of the nose, but in most patients no abnormality can be seen.

There is a common misunderstanding that this mucus drips into the lower airway and then infects the lungs, but this is untrue. It is, however, true that inflammatory disorders of the nose are closely linked with those of the chest.

Chronic infection within the sinuses may cause a mucopurulent discharge into the nasopharynx. Mucus may be visible in the oropharynx but endoscopy of the nose is often required to see the more subtle findings of a mucus track.

Primary and associated sinonasal symptoms