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  Post Nasal Drip  
 
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Conditions that suggest it | Recommendations

 

Post-nasal drip is a mucous accumulation in the back of the nose and throat leading to or giving the sensation of mucus dripping downward from the back of the nose. Chronic rhinitis is characterized by persistent irritation and inflammation of the lining tissues of the nose. One of the most common characteristics of chronic rhinitis is post- nasal drip. Post-nasal drip may lead to chronic sore throat. Post-nasal drip can be caused by excessive or thick secretions or an impairment in the normal clearance of mucus from the nose or throat. The following conditions are often associated with increased nasal drainage. Also, it would not be unusual to have more than one factor involved in a particular individual.

The following may cause an increase in thin secretions:

Viruses
Allergies
Cold temperatures
Specific foods or spices
Pregnancy or hormonal changes
Drug side-effects (particularly high blood pressure medications)
Structural problems (deviated septum, large turbinates)
Vasomotor rhinitis (an abnormal regulatory problem with the nose)
Decreasing the fluid content of the mucus usually thickens the secretions leading to the impression of increased mucus.

The following may cause thickened secretions:

Low humidity
Sinus or nasal infections
Foreign bodies: (especially if the drainage is from one side)
Environmental irritants: (tobacco smoke, smog)
Structural problems: (deviated septum, enlarged turbinates, enlarged adenoids)
Advanced age: mucus membrane lining the nose can shrink with age leading to a reduced volume of secretions that are thicker
Hormonal problems
Drug side-effects: (antihistamines)

Swallowing problems can make it difficult to clear normal secretions. This may result in the accumulation of material in the throat which can spill into the voice box causing hoarseness, throat clearing, or cough. The following factors can contribute to swallowing problems:

Advancing age: This will lead to decreased strength and coordination in swallowing.
Stress: Leads to muscle spasm or lump in throat. Also a nervous habit of frequent throat clearing will make the situation worse.
Narrowing of the throat or tumors: This will impair the passage of food.
Gastroesophageal reflux
Nerve or muscle disorders: (stroke, and muscle diseases, etc.)

Treatment of chronic rhinitis and post-nasal drip depends on the underlying condition causing the problem. A complete history and examination is done to determine if the problem is caused by either an impairment in the normal production of mucus or in its normal clearance from the nose.

Treatment options consists of one of more of the following:

Avoidance of allergens: An allergy is an exaggerated "normal body" inflammatory response to an outside substance. These substances that cause allergies are called allergens, and typically include pollen, mold, animal dander, house dust, and even some foods. The best treatment is avoidance of these allergens, but in many cases this may be impossible. Some helpful suggestions include:

Use a pollen mask when mowing the grass or cleaning the house; install an air purifier or at least change the air filters monthly; use cotton or synthetic materials such as Dacron in pillows and bedding; enclose mattress in plastic; consider using a humidifier; keep windows closed during high pollen times; eliminate house plants; and bathe frequently or even give away dander producing pets.

Avoidance of nasal irritants: Nasal irritants usually don't lead to the typical immune response seen with classical allergies, but nevertheless they can mimic or make allergies worse. Examples of these irritants include cigarette smoke, perfume, aerosol sprays, smoke, and smog & car exhaust.


Reflux Medications: Antacids (Maalox, Mylanta) help to neutralize acid contents, whereas other medications (Tagamet, Pepcid, Prilosec) decrease stomach acid production. Non-pharmacological treatments include avoiding late evening meals and snacks and the elimination of alcohol and caffeine. Elevating the head of the bed may help to decrease reflux during sleep.

Surgery: Structural problems with the nose and sinuses may ultimately require surgical correction. Obviously this should be done only after more conservative measures have been tried. Surgery is not a replacement for good allergy control and treatment. Septal deviation, septal spurs, septal perforation, enlargement of the turbinates, and nasal/sinus polyps can lead to pooling of or overproduction of secretions, blockage of the normal pathways leading to chronic sinusitis, and chronic irritation.
 

 
 

Conditions that suggest Post Nasal Drip:
 
 
Symptoms - Head - Nose  Nasal congestion
 
 

Recommendations for Post Nasal Drip:
 
 
Diet  Dairy Products Avoidance
 Milk, cheeses and other dairy foods tend to promote mucus production, which can trigger or aggravate postnasal drip.

  Juices / Juicing
 People with postnasal drip may benefit from drinking apple or dark grape juice, says John Peterson, M.D. He suggests drinking one eight-ounce glass every day, preferably before a meal. If the juice seems too strong, it can be diluted with water, he says. Cranberry juice can also be helpful, he adds.

  Increased Water Consumption
 Inadequate fluid intake will thicken secretions. Increasing the amount of water consumed may thin secretions for better elimination. Some people have a reduction or elimination of upper respiratory allergic symptoms when adequate water is consumed.

  Caffeine/Coffee Avoidance
 Eliminating caffeine from the diet may be helpful.

Drug

  Conventional Drugs / Information
 Allergy medications: Histamines are naturally occurring chemicals released in response to an exposure to an allergen, and they are responsible for the congestion, sneezing, and runny nose typical of an allergic reaction. Antihistamines are drugs that block the histamine reaction. These medications work best when given prior to exposure. Antihistamines can be divided into two groups: 1) Sedating (Benadryl, ChlorTrimetron, Tavist), 2) Non- Sedating (Claritin, Hismanal). Sedating antihistamines should be avoided in those patients who need to drive or use dangerous equipment. Non-sedating antihistamines can have serious drug interactions.

Decongestants: These drugs temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction. They may also stimulate the heart and raise the blood pressure and should therefore be avoided by patients who have high blood pressure, heart irregularity, glaucoma, thyroid problems, or difficulty in urination. The most common decongestant is pseudoephedrine (Sudafed).

Combinations: These drugs are made up of one or more anti-allergy medications. They are usually a combination of an antihistamine and a decongestant. Other common combinations include mucus thinning agents, anti-cough agents, aspirin, Advil, or tylenol. They help to simplify dosing and often will work either together for even more benefit or have side-effects that cancel each other out.

Allergy Shots (Immunotherapy): Allergy shots interfere with the allergic response. After identification of an allergen, small amounts of it is given back to the sensitive patient. Overtime the patient will develop blocking antibodies to the allergen, and they become less sensitive.

Steroids: These drugs (prednisone, medrol, hydrocortisone) are highly effective in allergic patients, however there is a potential for serious side effects when used over time. They are best used for the short term management of allergic problems, and must always be monitored by a physician.

Steroid nasal sprays: (Vancenase, Beconase, Flonase, Nasacort, Rhinocort) They reduce allergic or inflammatory inflammation, but do not have the side-effects of oral (systemic) steroids.

Nasalcrom: This spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine.

Decongestant sprays: (Afrin, Neosynpherine) They quickly reduce swelling of nasal tissues by shrinking the blood vessels. They will improve breathing and drainage over the short term, unfortunately if they are used for more than a few days they can become highly addictive (rhinitis metamentosa). Long term use can lead to serious damage.

Antihistamine sprays: It works like oral antihistamines but applied topically to the nasal membranes (Astelin).

Atrovent: It helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.

Mucus thinning agents: Mucus thinning agents are utilized to make secretions more thin and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin) and organic Iodine (Organidin) are commonly used formulations. If a rash develops or there is swelling of the salivary glands they should be discontinued.

Physical Medicine

  Hydrotherapy
 Wash the nose and sinuses with salt water: Nasal irrigation's utilizing a buffered hypertonic saline solution helps to reduce swollen and congested nasal and sinus tissues. In addition, it washes out thickened nasal secretions, irritants (smog, pollens, etc.), bacteria, and crusts from the nose and sinuses. Non-prescription nasal sprays (Ocean spray, Ayr, Nasal) can be used frequently, and are very convenient.

Nasal irrigation can be done several times per day, and is frequently performed with a syringe, a Water Pik device or Neti pot. The irrigating solution can be made by adding 2-3 heaping teaspoons of salt to one pint of water. It is best to use Morton Coarse Kosher Salt or Springfield plain salt because table salt may have unwanted additives. To this solution, add 1 teaspoon of baking soda. Store at room temperature, and always mix solution before each use. If the solution stings, use less salt. In the beginning, or for children, it is best to start with a weaker salt mixture. It is not unusual to initially have a mild burning sensation the first few times you irrigate.

While irrigating the nose, it is best to stand over the sink and irrigate each side of your nose. Aim the stream toward the back of your head, not at the top of your head. For young children, the salt water can be put into a small spray container which can be squirted many times into each side of the nose.

Another effective way to introduce the saline solution into the nasal passage is with a urinary catheter (with female Luer Lock fitting) attached to a 30-60cc syringe. This can then be inserted a short ways into the nasal passage.

Vitamins

  Vitamin B5 (Pantothenic Acid)
 
 


KEY
Proven definite or direct link
May do some good
Likely to help
Highly recommended







GLOSSARY

Allergen:  A substance that is capable of producing an allergic response in the body.

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Antacid:  Neutralizes acid in the stomach, esophagus, or first part of the duodenum.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Polyp:  A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.

Post-Nasal Drip:  A constant flow of mucous and discharge down the "back of the throat", generally caused by acute infection or allergies. This drip can in turn be responsible for the development of a secondary cough due to irritation of the larynx, and bronchospasm in asthmatic individuals.

Rhinitis:  Inflammation of the nasal mucous membrane.

Spasm:  Involuntary contraction of one or more muscle groups.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Stroke:  A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

Virus:  Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.