Postnasal Drip

Definition

Postnasal drip is a condition characterized by production of excess mucus secretion by the nasal mucous membrane and leading to number of annoying symptoms like cough, irritation in the throat and a constant urge to clear the throat. It is also known as upper airway cough syndrome. Severe cases of postnasal drip may lead to serious types of ear infection.

An allergy is the most common cause associated with postnasal drip; however, other causes like cold, flu and foreign objects impacted in the nasal cavity may also be responsible. Treatment options include management of the underlying problem along with relieving of symptoms by drugs like antihistamines and nasal decongestants.

Symptoms

Common presenting symptoms include :

  • Chronic cough typically seen at night after going to bed.
  • Constant urge to clear the throat because of dripping of secretions at the back of throat, increased spitting, constant swallowing and tickling sensation felt at the back of the neck.
  • Pain in the neck because of irritation of the throat mucosa by the increased secretion.
  • Runny nose.
  • Hoarseness of voice.
  • Congested nasal passages leading to difficulty in breathing and dryness of the oral cavity owing to mouth breathing, whistling sound during breathing (wheezing).
  • Headaches due to blockage of the sinus openings and accumulation of secretions.
  • Fatigue.
  • Nausea and sometimes vomiting.
  • Bad breath (halitosis),

In some cases with excessive postnasal drip there is increased risk of ear infection leading to ear pain, discharge from the ear and temporary impairment of hearing.

Causes

The upper airway starting from the nasal cavity is covered with a protective lining of mucous membrane which produces mucus. It is prevents the airborne foreign substances including bacteria and viruses from entering the lungs by trapping it. Usually this mucosa along with saliva produced by the oral cavity drips down the throat and is subsequently swallowed throughout the day without being noticed.

If there is increased production of mucosa, the excess mucus tends to come out from the nasal openings as a runny nose and runs down the back of the throat as postnasal drip. The common causes associated with increased mucus secretions include :

  • Allergy, usually this type of postnasal drip shows seasonal variation or with certain changes in environmental factors like exposure to dust, pollen, cold, spicy foods, pollutant and irritant gases.
  • Common cold and attacks of the flu.
  • Inflammatory changes in the sinuses (sinusitis) leading to blockage of the draining pathway of the fluids and thereby increased accumulation of mucus.
  • Foreign body impacted in the nasal cavity blocking the natural course of drainage of the mucus.
  • Pregnancy.
  • Intake of certain drugs like blood pressure lowering medications or contraceptive pills.

Sometimes post nasal drip may be seen without excess production of mucuss as there is other underlying problems like :

  • Swallowing difficulties.
  • Impairment of motility of the esophagus.
  • Gastroesophageal reflux disease.

Having a history of allergies, being regularly exposed to environmental dusts and cigarette smoking are some of the risk factors for developing postnasal drip.

Treatment

Postnasal drip can be difficult to treat at times and most measures are aimed at providing symptomatic relief. Even when it does resolve it may recur. Management of underlying disease is the focus. Other treatment measures include :

  • Using nasal decongestants and antihistamines.
  • Steam inhalation.
  • Antibiotics may be prescribed if associated with infection.
  • Using saline nasal spray to get rid of excess mucus.

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