POST-NASAL DRIP – How and Why?
Study of normal and abnormal secretions
What is Post-nasal Drip?
The glands in the nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. The mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of the nose is called post-nasal drip. This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.
Causes of Abnormal Secretions – Thin and thick
Increased thin clear secretions is due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils).
Infective secretions with polypi in nose
A common cause for post nasal drip.
Increased thick secretions in the winter often result from too little moisture in the heated or air conditioned buildings and homes. They also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.).
Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral “cold” that persists for 10 days or more may have become a bacterial sinus infection. With this infection, there is increased post-nasal drip. If there is a suspicion of sinus infection one should see a physician for antibiotic treatment.
Chronic sinusitis: This occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an examination of the interior of the nose with a fiberoptic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended.
Vasomotor rhinitis: It describes a nonallergic “hyperirritable nose” that feels congested, blocked, or wet.
This may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat, and food passage (esophagus) does not work properly secretions can overflow into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough.
Several factors contribute to swallowing problems:
- With age, swallowing muscles often lose strength and coordination. And even normal secretions may not pass smoothly into the stomach.
- During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed when awakening.
- When nervous or under stress, throat muscles can trigger spasms that feel like a lump in the throat. Frequent throat clearing, usually produces little or no mucus, can make the problem worse by increasing irritation.
- Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids.
These problems may be caused also by gastroesophageal reflux disease (GERD). This is a return of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.
Chronic Sore Throat:
Acute inflammation of the throat due to infection. It is also called as Acute Pharyngitis. Post-nasal drip often leads to a sore, irritated throat. There is usually no infection, the tonsils and other tissues in the throat may swell. This also causes discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.
Treatment for Postnasal drip
A correct diagnosis requires a detailed ear, nose, and throat examination and possible laboratory, endoscopic, and x-ray studies. Each treatment is different:
- Bacterial infection: when it is present, is treated with antibiotics. Drugs may provide only temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.
- Allergy: This is managed by avoiding the cause if possible. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy (allergy shots) also may be helpful. Some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer non-sedating antihistamines, available by prescription only, do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid drops generally may be used safely under medical supervision. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, oral–injectable, steroids must be monitored carefully when used for more than one week.
- Gastroesophageal reflux: It is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids (e.g., Gelusil, Digene ) and drugs that block stomach acid production (e.g., Zinetec, Rantac, Ocid) or more powerful medications may be prescribed. A trial treatment may be suggested before x-rays and other diagnostic studies are performed.
- General measures: For thinning secretions, so that they can pass more easily may be recommended when it is not possible to determine whether an existing structural abnormality is causing the post-nasal drip or if some other condition is to blame.
Many people, especially older persons, need more fluids to thin secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (fluid pills) will help. Mucous-thinning agents such as guaiphenesin may also thin secretions.
Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik with a nasal irrigation nozzle. Warm water with baking soda or salt (1/2 to 1 tsp. to the pint) or Alkaline douche, a nonprescription irrigating solution may be helpful. Finally, use of simple saline (salt) nonprescription nasal drops or sprays (e.g., Nasivion.s, Nasoclear) to moisten the nose is often very beneficial.