Why do I have frequent mucus clumps despite surgery?

Question

Hello doctor,

I am a 23-year-old male. When I was around 18, I started noticing clumps of mucus (thick nasal secretions) that would accumulate above my soft palate (the upper part of the throat). I could not blow or swallow them; they just sat there until I coughed or grunted them out. Initially, I didn't think much of it, but over time, it worsened, and I had to clear it once or twice a day.

I consulted an ENT specialist (ear, nose, and throat specialist) and tried nasal irrigation with steroids, but it did not provide relief. The ENT then performed a nasal endoscopy, which appeared structurally normal, but he recommended a CT scan. The CT scan showed that my right maxillary sinus was filled, and there was a growth blocking the drainage point.

I underwent sinus surgery (functional endoscopic sinus surgery (FESS), during which the ENT removed the growth and corrected my deviated nasal septum. The diagnosis was chronic sinusitis.

Not long after surgery, I started vaping and smoking again, and although the mucus clumps returned, they were smaller, less frequent, and without any odor. This continued for a few years.

I stopped vaping last year, and overall, things improved. However, I have recently noticed that my left side feels puffy, and I now experience the same mucus clump once every one to two weeks, which has an unpleasant odor. It looks similar each time. My questions are:

Is this normal after sinus surgery, or could it suggest a persistent or recurrent sinus infection?
Should I consult an ENT specialist again or undergo any follow-up imaging?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Persistent mucus clumps in your throat, recurring after sinus surgery and now accompanied by left-sided puffiness and foul-smelling mucus, are not uncommon in patients with a history of chronic sinusitis (long-term sinus inflammation) and sinus surgery. You should seek further evaluation with an ENT (ear, nose, and throat) specialist. If the mucus becomes malodorous or you notice new, progressive, or persistent puffiness, it may represent infection, polyp recurrence, or chronic inflammation, which requires professional assessment.

One-sided symptoms or changes, especially appearing years after surgery, should be checked with nasal endoscopy and possibly repeated imaging (CT scan) to rule out new blockage, recurrent polyp, or other underlying causes. Post-nasal drip is common in chronic sinusitis, but it is treatable and should be managed for a better quality of life.

Please book a follow-up with your ENT, especially considering the recent increase in odor and swelling on one side. This will allow direct visualization, assessment for infection, and help rule out recurrence or complications. Continue regular nasal saline irrigation, as advised, and monitor for worsening symptoms such as facial pain, fever, or thick discharge. Avoid smoking and vaping, as they worsen inflammation and delay healing.

If infection or recurrence is suspected, nasal endoscopy, a repeat CT (computed tomography) scan, or a mucus culture is recommended to guide further treatment. Medical therapy such as nasal steroids, antibiotics, or antihistamines may help if ongoing inflammation or infection is confirmed.

While some residual or intermittent symptoms can occur after sinus surgery, the recurrence of foul-smelling mucus and swelling, especially on one side, needs further evaluation to ensure there is no recurrence or new complication.

I hope this helps you.

Thank you.