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Alleviating the Discomfort of Postnasal Drip

NEW YORK (Aug 1, 2012)

The symptoms of postnasal drip can be frustrating: a tickle in the back of the throat, nagging cough, and sore throat. So can understanding the source.

"The biggest misconception about postnasal drip is that it is a separate disease when really it is a signal to the body that something is going wrong," explained otolaryngologist William Reisacher, M.D.

William Reisacher, M.D.
William Reisacher, M.D.

Adults make about 1-1.5 liters of mucus daily. It's typically thin and water-like and lubricates the nose, throat, vocal cords, esophagus, and other areas in the body. Typically, we swallow most of it without even knowing. But, there are events that can change this.

"When the body is exposed to an irritant such as a virus, allergies, bacteria, chemicals, or dryness in the air, said Dr. Reisacher, "it thickens the mucus as a defense mechanism," creating a more acidic substance that burns the throat.

Additionally, "anatomic abnormalities in the nose, such as a deviated nasal septum, can contribute to inflammation of the nose, called rhinitis, and in turn lead to increased mucous production, pooling, and postnasal drip," said Deya Jourdy, M.D., also an otolaryngologist.

Deya Jourdy, M.D.
Deya Jourdy, M.D.

The cause also can be side effects of medications or hormonal changes such as those during pregnancy, which change the composition of mucus.

Many patients with "acid reflux may also have throat irritation, hoarseness, frequent throat clearing, and/or a feeling of having a 'lump in the throat,' which may be mistaken for postnasal drip," Dr. Jourdy said. This adds to the importance of seeing your doctor to help pinpoint the cause of your symptoms.

Finding the Cause of Postnasal Drip

Along with questions about the onset, duration, and severity of symptoms, ENT (ear, nose, and throat) doctors may examine the nose and throat with a rigid telescope or flexible fiber-optic scope. They also may order allergy or immunological testing, or culturing of nasal discharge (to determine the type of bacteria causing an infection). Imaging such as MRI or CT scans can also be used to visualize the head, particularly the nose, sinuses, and throat.

Be forthright during exams. Allergy medications like antihistamines (when used over a long period of time) can cause dryness, contributing to postnasal drip. "It is important to tell your doctor all of the medications you are taking," Dr. Reisacher said.

If postnasal drip is associated with other symptoms such as "persistent hoarseness, difficulty or painful swallowing, weight loss, choking, a neck mass, or other concerning symptoms, the patient should seek medical evaluation as soon as possible as this constellation of symptoms could be a sign of a more serious problem," Dr. Jourdy said. "This is especially true for patients with a history of tobacco or alcohol use due to the increased risk of cancer, and those with worsening symptoms despite treatment," he added.

Treatment Options

The treatment for postnasal drip largely depends on the cause of the symptoms. "Multiple treatment options exist, ranging from simple nasal saline rinses, aggressive hydration, and allergen avoidance, to topical or oral medications and more aggressive treatment like surgery," Dr. Jourdy said.

When initial symptoms arise, Dr. Reisacher recommends drinking six to eight glasses of water a day; using non-medicated nasal saline spray several times a day; using a cool mist humidifier in dry environments; and taking mucolytics, also known as expectorants, which are mucus thinners that are available over-the-counter. But, if symptoms persist, be sure to visit a doctor for evaluation.

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