What is Post-Nasal Drip?

The glands in your nose and throat continually produce mucus which moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter and fights infection. The feeling of mucus accumulating in the throat or dripping from the back of your nose is called post-nasal drip and can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.

What causes Abnormal Secretions – Thin and Thick

An increasing thin, clear secretion can be 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 such as an irregular nasal septum.

Increased thick secretions in the winter often result from a lack of moisture in heated buildings and homes. It can 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.

Sinuses drain into the nose through small openings. Blockages in the sinuses 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 and you may notice increased post-nasal drip. If you suspect that you have a sinus infection, you should see your physician for antibiotic treatment.

Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polvps (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 exam of the interior of the nose with a fiberoptic scope and CAT scan x-ravs. If medication does not relieve the problem, surgery may be necessary.

Swallowing Problems

Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat and esophagus aren’t working properly, overflow secretions can spill 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. Thus, 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, which 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.
Chronic Sore Throat

Post-nasal drip often leads to a sore, irritated throat. Although there is usally no infection, the tonsils and other tissues in the throat may swell. This can cause 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

A correct diagnosis requires a detailed ear, nose and throat exam and possible laboratory, endoscopic and X-ray studies. Each treatment is different:

Bacterial infection, when present, is treated with antibiotics. These drugs may provide our temporary relief. In cases of chronic sinusitis, surgery to open the hocked sinuses may he required.

Allergies are managed by avoiding allergens, if possible. Allergy shots, antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays and other forms of steroids may offer relief. Some older, sedating antihistamines may dry and thicken post-nasal secretions even more and newer non-sedating antihistamines, available by prescription only do not have this effect.

Gastroesophageal reflux 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 cutting alcohol and caffeine from the daily diet. Antacids (Maalox®, Mylanta®, Gaviscon ® ) and drugs that block stomach acid production (Zantac®, Tagamet®, Pepcid®) 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 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 the elderly, need more fluids to thin secretions. Drinking more water, eliminating caffeine and avoiding diuretics (fluid pills) will help. Mucus thinning agents such as guaifenesin (Humibid®, Robitussin®) 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 Alkcalol®, a nonprescription irrigating solution, may be helpful. Finally, use of simple saline  nonprescription nasal sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very beneficial.