POST NASAL DRIP: TURNING OFF THE FAUCET

Everyone has experienced post nasal drip. It is that uncomfortable feeling of mucus fullness that seems to lodge just above the tonsils. It can make you clear your throat constantly to clear away the mucous that moves on down to your vocal cords and makes you intermittently hoarse. It makes some people snort every now and then; it can cause a tickly cough at night that just won't seem to go away. Heaven forbid, it makes some people spit like grasshoppers. It is probably the biggest reason Americans spend zillions of dollars on over the counter cough and cold medicines. The purpose of this article is to try and uncover as many possible causes of post nasal drip, or PND, that we can, and to suggest reasonable solutions to the problem. If you look at a cross-section of the nose, you will see that there is a gentle interior tilt toward the back of the throat. Hence, when there is mucous and irritation within the nose, guess where it goes? The most common irritants of the nose are probably the air constituents that we breathe in moment to moment. Gas fumes, dust, animal dander, pollen are examples to name a few. The nose reacts to these irritants by making protective mucous. Sometimes this helps to propel the irritants out of the nose; sometimes it backfires and keeps them there. When the nose has a super-reactive response to irritants, the person is said to have vasomotor rhinitis. A separate issue is allergic rhinitis. This is where the nose has a very specific inflammatory reaction to a certain substances, such as dust, dander, cigarette smoke, or one particular type of pollen. In these cases the front of the nose often swells, further directing the mucus to the back of the throat. Nasal inflammation as a cause of PND brings to mind a current treatment which can be quite effective. This is either the use of saline nose drops, or saline nasal irrigation. The purpose is to wash away the irritants or allergens which keep the process going. It removes white blood cells and inflammatory cytokines which promote inflammation. One cause of chronic post nasal drip is sinusitis. Often this inflammatory state is subclinical, and the person may lack the classic symptoms of sinusitis. The sinus openings are under the nasal turbinates, which tilt back toward the throat. So, in certain cases, getting rid of PND is just a matter of treating what is ailing the sinuses. It can be a chronic infection for which antibiotics can bring resolution. Sometimes it is allergic sinusitis: the sinuses are lined with the same mucous membranes as the nose. In these cases a corticosteroid nasal spray might resolve the problem. Or maybe the allergic reaction might respond to one of the newer, non-sedating antihistamine tablets. The evaluating physician might want to look at a sinus CT scan or look at the sinus openings through a tiny flexible scope. Post nasal drainage may be due to direct inflammation of the posterior pharynx. Certain tell-tale signs might be stones in the tonsils or a cobble-stone appearance to the mucosa. Sometimes this is seen when there is an allergy to cow's milk. Sometimes, the nose is so congested that the person becomes a mouth-breather, and the same irritative substances are deposited directly on the back of the throat. There always seems to be excess mucous and saliva at the recess behind the tongue. Post nasal drainage can be the result of certain digestive disorders. One cause is gastroesophageal reflux disease, or GERD. In this case stomach contents and acid reflux back up the esophagus, and can inflame the throat, nasopharynx, or the epiglottal opening at the trachea. The treatment for this can be H2 blockers like famotidine, or proton pump inhibitors like omperazole. People can have other swallowing disorders which contribute to nasopharyngeal inflammation. Certainly older people can have problems with spasticity or dysfunction of the swallowing muscles and their reflex actions. As you can see, the evaluation of post nasal drip can fall into the realms of several different specialties. The nose and sinuses are the turf of Ear, Nose, and Throat (ENT) specialists. Reflux disorders belong to the gastroenterologists, and certain swallowing disorders would be of interest to a neurologist. Of course allergic conditions would fall to the allergist for specialty testing and treatment. It's probably the best idea for you to start with a good physician, and let him sort through the possible causes of your PND. He can then make referrals as necessary, or initiate a trial of treatment aimed at your specific disorder. John Drew Laurusonis, M.D. Doctors Medical Center