Clear Up Post-Nasal Drip and Feel Good Again

Glands in your nose and throat continually produce mucus (one to two quarts a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called postnasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders.

What causes abnormal secretions?
Increased thin, clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods or spices, gastroesophageal reflux, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum.

Increased thick secretions in the winter often result from dryness in heated buildings and homes. They can also result from sinus or nose infections and allergies, especially to foods, such as dairy products. If thin secretions become thick and turn 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 small toy. If these symptoms are observed, seek a physician for examination.

Increased thin, clear secretions can be due to colds and flu,
allergies, and cold temperatures.

How is swallowing affected?
Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerves and muscles in the mouth, throat, and food passage aren’t interacting properly, overflow secretions can spill into the voice box and breathing passages, causing hoarseness, throat clearing, or coughing.

How is the throat affected?
Postnasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

How is post-nasal drip treated?
A correct diagnosis requires a detailed ear, nose, and throat exam, and possibly laboratory, endoscopic, and X-ray studies. Treatment varies according to the cause of the post-nasal drip. Bacterial infections are treated with antibiotics. These drugs may only provide temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.

Allergies are managed by avoiding the causes. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy, either by shots or sublingual (under the tongue drops), may also be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays 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, steroids must be monitored carefully when used for more than one week.

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 eliminating alcohol and caffeine from the daily diet. Antacids and drugs that block stomach acid production may be prescribed. If these are not successful, stronger medications can be prescribed.

General measures that allow mucus secretions to pass more easily may be recommended when it is not possible to determine the cause. Many people, especially older persons, need more fluids to thin out secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (medications that increase urination) will help.

Mucous-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 with a nasal irrigation device. Finally, use of simple saline non-prescription nasal sprays to moisten the nose is often very beneficial.

What do I need to know about sinus conditions?
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. This infection may increase post-nasal drip. If you suspect that you have a sinus infection, you should see your physician to see if it needs antibiotic treatment.

Chronic sinusitis occurs when sinus blockages persist, causing the lining of the sinuses to swell further. Polyps may develop with chronic sinusitis. People with polyps tend to have irritating, persistent post-nasal drip. If medication does not relieve the problem, surgery may be recommended.