Post-nasal drip

Post-nasal drip (PND) occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of the throat.[1] It can be caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD / GORD), or by a disorder of swallowing (such as an esophageal motility disorder). Other causes can be allergy, cold, flu, and side effects from medications.[2]

Post-nasal drip
Other namesUpper airway cough syndrome, UACS, or Post nasal drip syndrome
Post-nasal drip
SpecialtyOtorhinolaryngology

However, some researchers argue that the flow of mucus down the back of the throat from the nasal cavity is a normal physiologic process that occurs in all healthy individuals.[3] Post-nasal drip has been challenged as a syndrome and instead is widely viewed as a symptom by various researchers as a result of the wide variation among differing societies. Furthermore, this rebuttal is reinforced because of the lack of an accepted definition, pathologic tissue changes, and available biochemical tests.[3]

Signs and symptoms

PND may present itself through the constant presence of discomfort in the upper airways. This is caused by the flow of mucus from nasal membranes down the back of the throat, triggering a cough. The cough can become more pronounced in some cases as the result of heightened response to infections.

GERD (GORD) is often associated with a high prevalence of upper-respiratory symptoms similar to those of PND, such as coughing, throat clearing, hoarseness and change in voice. Reflux causes throat irritation, leading to a sensation of increased mucus in the throat, which is believed to aggravate and, in some cases, cause post-nasal drip.

Post-nasal drip can be a cause of laryngeal inflammation and hyperresponsiveness, leading to symptoms of vocal cord dysfunction.[4][5]

Diagnosis

A prolonged period of examination based on information gathered from the patient regarding the chronology of the dripping sensation in the throat, evident within PND, can be unreliable and cause bias in diagnosing the syndrome itself in the absence of any accurate and objective diagnostic tests. As such, suggestive procedures that highlight rhinitis and mucopurulent secretions, such as nasoendoscopy, may instead be utilised because of the vague nature of information available to directly attribute specific symptoms to the syndrome.[6][7]

Treatment

Treatment options depend on the nature of an individual’s post-nasal drip and its cause. Antibiotics may be prescribed if the PND is the result of a bacterial infection.[1] Antihistamines are recommended if the PND is caused by allergies. However, first-generation antihistamines can have side effects, including drowsiness.[8] Nasal steroid treatments, such as fluticasone propionate, may also provide relief.[9] Decongestants such as pseudoephedrine cause a reduction in membranes through the tightening of blood vessels, which results in reduced PND.[10]

Staying hydrated and avoiding alcoholic and caffeinated products that can worsen symptoms is key. Avoiding cigarette smoke is also recommended because it can cause increased discomfort if inhaled. Drinking more fluids, especially those that can thin mucus (such as hot liquids), can be beneficial. Nasal irrigations such as saline-based nose sprays can be used to help with secretions in the throat that may cause discomfort. Physicians may also prescribe steroid-based nasal sprays, which are safe and more effective than over-the-counter decongestant sprays that may only remain helpful for a limited period of time.[1][10]

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References
  1. Australia, Healthdirect (2018-04-06). "Post-nasal drip". Retrieved 2018-09-21.
  2. "Postnasal Drip: Causes, Treatments, Symptoms, and More". WebMD. Retrieved 2018-04-02.
  3. Morice, AH (2004). "Post-nasal drip syndrome--a symptom to be sniffed at?". Pulmonary Pharmacology & Therapeutics. 17 (6): 343–5. doi:10.1016/j.pupt.2004.09.005. PMID 15564073.
  4. Ibrahim, Wanis H.; Gheriani, Heitham A.; Almohamed, Ahmed A.; Raza, Tasleem (2007-03-01). "Paradoxical vocal cord motion disorder: past, present and future". Postgraduate Medical Journal. 83 (977): 164–172. doi:10.1136/pgmj.2006.052522. ISSN 1469-0756. PMC 2599980. PMID 17344570.
  5. Gimenez; Zafra (2011). "Vocal cord dysfunction: an update". Annals of Allergy, Asthma & Immunology. 106 (4): 267–274. doi:10.1016/j.anai.2010.09.004. PMID 21457874.
  6. Pratter, Melvin R. (2006). "Chronic Upper Airway Cough Syndrome Secondary to Rhinosinus Diseases (Previously Referred to as Postnasal Drip Syndrome )". Chest. 129 (1): 63S–71S. doi:10.1378/chest.129.1_suppl.63s. ISSN 0012-3692. PMID 16428694.
  7. Sylvester, Deborah C.; Karkos, Petros D.; Vaughan, Casey; Johnston, James; Dwivedi, Raghav C.; Atkinson, Helen; Kortequee, Shah (2012). "Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist". International Journal of Otolaryngology. 2012: 564852. doi:10.1155/2012/564852. ISSN 1687-9201. PMC 3332192. PMID 22577385.
  8. "Postnasal Drip: Causes, Treatments, Symptoms, and More". WebMD. Retrieved 2018-04-02.
  9. "Can Nasal Steroids Ease Allergy Symptoms?". WebMD. Retrieved 2018-04-02.
  10. Publishing, Harvard Health. "That nagging cough - Harvard Health". Harvard Health. Retrieved 2018-09-21.
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External resources
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