Post-Nasal Drip

A lot of people in South Mississippi complain of post-nasal drip. Everything from stuffy nose to feelings of phlegm in the throat or feelings of excessive clearing the throat and cough are attributed to post-nasal drainage.

Actually post-nasal drainage is very rare as far a disease process is concerned. A lot of people that have what they think is post-nasal drainage is due to something quite different from what they think. Post-nasal drainage in most peoples’ minds means “sinus disease”. However, it is much more common for post-nasal drainage to be something else. It is normal for the nose to drain secretion post-nasally. It is part of the natural pattern of humidifying the air, cleaning the air of dust and bacteria, as well as warming the inspired air in preparation for lung utilization.

More than a quart of fluid is produced by the nose everyday, but it is usually not felt because it is used in the inspired air and does not coat the posterior pharynx. There are conditions that do cause post-nasal drainage and these are usually sinusitis infections, that is, a bacterial infection of the maxillary or ethmoid sinuses in the nose. These are associated with other symptoms besides post-nasal drainage. “All post-nasal drainage is not sinus.” Sometimes it takes a examination by an ear, nose and throat specialist to detect what is the cause of the post-nasal drainage. The vast majority of the people that complain of post-nasal drainage actually have gastro-esophageal reflux disease, or what we here at the Ear, Nose and Throat & Facial Plastic Surgery, P.A. call “laryngo-pharyngeal disease”. That is a reflux of acid from the stomach that comes up the esophagus into the pharynx. It causes little or no symptoms in the esophagus, that is, there is no heartburn associated, but acid contamination of the lining of the throat around the Adam’s apple or larynx is irritated quite easily by the acid. The reason for this is that there are no intrinsic defense mechanisms to neutralize the acid in the pharynx like there are in the esophagus. It takes quite a dose of acid to cause esophageal indigestion symptoms, but it takes only a drop or two to of acid to create laryngeal pharyngeal symptoms. It is quite natural to have 50 episodes of acid reflux into the distal esophagus on a daily basis. However, if one drop of acid gets into the throat area around the larynx three times a week, symptoms can occur. Differentiation of post-nasal drainage causes is a very difficult procedure.

It seems like it would be quite easy to treat the sinus trouble and get rid of the problem, but often it is a multi-faceted problem and requires direct examination of the nose and throat to reach a correct diagnosis. Once the diagnosis is made, treatment is rather easy and can alleviate most of the trouble in a few days. Some simple things that could improve post-nasal drainage are increasing water intake on a daily basis. We have all heard that we should drink 12 glasses of water a day. That is true and, in the winter months, we probably should drink more because the heat in the environment that we live and breathe on a daily basis dries out our nasal secretions quite a bit and causes them to be thick and tenacious. Saline nasal spray is easy to obtain over the counter and helps in nasal dry conditions that aggravate post-nasal drainage. Proper diet, weight loss and anti-reflux measures will improve disease and help control post-nasal drainage. Sometimes prescription medications are necessary although over-the-counter medicines such as Pepcid, Zantac, Axtid, or Tagamed will give relief. Usually over-the-counter medicines are not strong enough in the standard dosage and you have to double the dose, but I recommend you consult your regular physician prior to using over-the-counter medications. Also, using antacids such as Tums, Mylanta, Malox can control laryngeal pharynx reflux symptom. If thick post-nasal drainage symptoms continue to aggravate, I recommend you to see your local physician or your ear, nose and throat specialist for further evaluation and treatment.