Post-nasal drip

Post-nasal drip (PND, also termed upper airway cough syndrome, UACS, or post nasal drip syndrome, PNDS) occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the throat or back of the nose. It is caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing (such as an esophageal motility disorder). It is frequently caused by an allergy, which may be seasonal or persistent throughout the year.

However, other researchers argue that mucus dripping down the back of the throat from the nasal cavity is a normal physiologic process that occurs in healthy individuals.^[1] Post-nasal drip syndrome as a concept has been challenged due to a lack of an accepted definition, a lack of any pathologic tissue changes and no available biochemical tests. The phrase has been described as a "pseudo-syndrome" (i.e. not a real medical condition) which serves as a catch-all, waste-basket phrase that is unhelpful.^[1] However normal mucus production doesn't cause people major symptoms as listed below whereas excessive mucus production in the nose can cause sore throat wheezing coughing as seen in viral, bacterial and allergic/non allergic conditions.

Associated conditions

PND is suggested to be a cause of extra-oral halitosis, especially when a sinus infection is also present. Acid reflux or heartburn is believed to aggravate and in some cases cause post-nasal drip.^[2]

Symptoms

Individuals may be diagnosed as suffering from post-nasal drip if they suffer from the following symptoms:

• Coughing;
• Wheezing
• Constant swallowing, which can lead to an excessive amount of air in the stomach, causing discomfort;
• Rhinorrhea, running nose due to mucus flow;
• Frequent spitting;
• Tickling in the throat;
• Constant clearing of throat;
• Rigid burning sensation at back of the throat;
• Broken or cracking voice;hoarseness
• Mucus feeling in the back of the throat;
• Difficulty in breathing;
• Congestion in the nasal and sinus passages;
• Chronic sore throat;
• Masses formed in the crypts of the tonsils that are generally yellow or white (commonly called tonsil stones, or tonsilloliths);
• Halitosis (bad breath);
• Snorting to clear mucus from the nasal passage that cannot otherwise be cleared by blowing one's nose;
• Cobblestone appearance of the oropharyngeal mucosa;
• Frontal cranial pressure;
• Fatigue;
• Nausea;
• Vomiting.

Treatment

First and foremost, as the causes are manifold, a removal of those causes should be targeted. Treatment may include antibiotics, decongestants, nasal irrigation, sinus massage, acid control medication, allergy medication, and minor surgery. Bulb syringes, squirt bottles, pulsatile nasal irrigators or neti pots are often used for nasal irrigation. Allergy medications include antihistamines, decongestants, nasal steroids alone or in combination. Allergy injections may be used for long-term relief when allergy is the cause. Oral steroids may be prescribed for short-term use in some situations.

According to the evidence-based cough guidelines published by the American College of Chest Physicians in the January 2006 issue of Chest, a first-generation antihistamine should be employed as first-line therapy to treat post-nasal drip.

References

External links

• Medline Plus article on Nasal Discharge