Postnasal Drip Syndrome

Postnasal drip syndrome, also widely known as Upper Airway Cough Syndrome (UACS), is a common condition where excess mucus drips down the back of the throat from the nasal passages or sinuses. This sensation can lead to chronic throat irritation, frequent throat clearing, and a persistent cough.

Causes:

Postnasal drip is often caused by conditions that lead to overproduction of mucus or impaired mucus clearance.

• Allergies (Allergic Rhinitis):
  • Seasonal Allergies: Pollen (trees, grasses, weeds) can trigger excessive, watery mucus production, especially during specific seasons.
  • Perennial Allergies: Indoor allergens like dust mites, pet dander, and mold can cause year-round mucus production and inflammation.
• Non-Allergic Rhinitis:
• • Vasomotor Rhinitis: Blood vessels in the nose overreact to non-allergic triggers (e.g., changes in temperature, humidity, strong odors, irritants like smoke), leading to runny nose and drip.
  • Irritants: Exposure to tobacco smoke, pollution, chemical fumes, or strong perfumes.
  • Infections: Viral infections (common cold, flu) or bacterial sinus infections (sinusitis) cause increased and often thicker mucus.
• Sinusitis (Sinus Infection): Inflammation of the sinuses can lead to thick mucus buildup and drainage down the throat. This can be acute or chronic.
• Gastroesophageal Reflux Disease (GERD) / Laryngopharyngeal Reflux (LPR): Stomach acid or contents back up into the esophagus and sometimes reach the throat and voice box, irritating them and triggering increased mucus production as a protective response.
• Anatomical Abnormalities:
  • Deviated Septum: A crooked nasal septum can hinder proper drainage.
  • Nasal Polyps: Growths in the nasal passages or sinuses can block drainage.
• Environmental Factors: Dry air (e.g., from heating systems), low humidity.
• Certain Medications: Some blood pressure medications (e.g., ACE inhibitors), hormonal therapies.
• Food Sensitivities: Some individuals find certain foods (e.g., dairy) can worsen mucus production.

Symptoms:

The primary symptom of postnasal drip is the sensation of mucus running down the back of the throat. Other common symptoms include:

• Frequent throat clearing: A persistent urge to clear the throat.
• Chronic cough: Often worse at night or upon waking, can be dry or produce phlegm. This is why it’s often called Upper Airway Cough Syndrome.
• Sore throat or scratchy throat.
• Hoarseness or voice changes.
• Frequent swallowing.
• Feeling of a lump in the throat (globus sensation).
• Nasal congestion or stuffiness.
• Runny nose.
• Bad breath (halitosis).
• Ear pressure or fullness.
• Nausea (from swallowing excess mucus).

Diagnosis:

Diagnosing postnasal drip syndrome involves a thorough medical history, physical examination, and sometimes specific tests to identify the underlying cause.

• Medical History and Physical Exam: The doctor will ask detailed questions about your symptoms, triggers, duration, and any related medical conditions (allergies, asthma, reflux). They will examine your nose, throat, and possibly your ears.
• Nasal Endoscopy: A thin, flexible, lighted tube with a camera is inserted into the nose to visualize the nasal passages, sinuses, and throat for inflammation, polyps, mucus, or reflux signs.
• Allergy Testing: If allergies are suspected, skin prick tests or specific IgE blood tests may be performed.
• Sinus CT Scan: If chronic sinusitis is suspected as the cause.
• Reflux Evaluation:
  • Trial of reflux medications: Taking proton pump inhibitors (PPIs) for a period to see if symptoms improve.
  • pH monitoring: In some cases, a small probe is placed in the esophagus to monitor acid reflux over 24 hours.
• Sputum Culture: If a bacterial infection is suspected, mucus may be cultured to identify the pathogen.

Treatment:

Treatment for postnasal drip syndrome focuses on managing the underlying cause, reducing mucus production, and clearing the airways.

• Treating the Underlying Cause:
  • Allergies: Allergen avoidance, antihistamines (oral or nasal sprays), nasal corticosteroids, and potentially allergen immunotherapy.
  • Sinusitis: Antibiotics for bacterial infections, nasal corticosteroids, saline rinses, and possibly surgery for chronic cases.
  • Reflux: Acid-reducing medications (PPIs, H2 blockers), dietary changes (avoiding trigger foods), and lifestyle modifications (e.g., elevating the head of the bed, not eating close to bedtime).
• Mucus Management:
• • Saline Nasal Rinses/Sprays: Help thin and flush out mucus from the nasal passages.
  • Hydration: Drinking plenty of water can help thin mucus.
  • Humidifiers: Adding moisture to the air can help, especially in dry environments.
  • Mucolytics: Over-the-counter medications like guaifenesin (expectorants) may help thin mucus.
• Symptom Relief:
• • Decongestants: (e.g., pseudoephedrine, phenylephrine) can help reduce nasal congestion. Use nasal decongestant sprays cautiously for only a few days to avoid rebound congestion.
  • Cough suppressants: For severe cough, but addressing the underlying cause is more effective.
• Lifestyle Adjustments:
• • Avoid irritants: Steer clear of smoke, strong perfumes, and other airborne irritants.
  • Elevate head during sleep: Can help reduce reflux and postnasal drip at night.
  • Avoid trigger foods: If specific foods worsen mucus.

Long-term management often involves identifying and consistently addressing the primary underlying cause of the postnasal drip.