Post Nasal Drip
Patrick O’Neil, PA
Post nasal drip is one of the most common, and most misunderstood ailments that I see. Even in the medical community, I see patients for follow-up examinations that have been suffering with this for weeks. Their provider gave them one or two meds, but did not fully treat the process they were having. Even worse, they may have been treating it completely wrong. Many diagnoses of Sinusitis are really nothing more than post nasal drip syndrome.
What Causes Post Nasal Drip Syndrome?
Post nasal drip can be caused my multiple factors.
► Allergies are the most common reason for post nasal drip.
► Ambient temperature changes, such as going in and out of air conditioning into a hot environment.
► Humidity changes
Basically, think of post nasal drip as the sinuses reaction to something that is irritating them. When the lungs are irritated, we get a cough. When the sinuses are irritated, they put out extra fluid. For the vast majority of the population, when the sinuses start flowing, the drip goes down the back of the throat. If the sinuses are putting out a lot of fluid, they will drip down the back and the front of the nasal passages, resulting in a “runny nose.” The symptoms are usually more pronounced while we are sleeping. Think of it like this: When you are standing or sitting, the drip runs down the back of the throat at a fairly rapid pace. When you are laying down, that drip now moves very slowly. This is why the symptoms are initially worse during the night, while we are laying in a horizontal position. Some patients will even say they feel better sleeping in a recliner, because the drip is now moving faster and the symptoms are not as severe.
The patient suffering from classic post nasal drip syndrome will come in with a complaint of:
► A dry cough that is worse at night.
► The throat has a tickle and may be sore in the mornings.
► Phlegm/drip going down the back of the throat.
► Sinus congestion/pressure.
► Ears with pressure or a “popping” sensation.
►They will normally deny having fever, chills, muscle aches, and joint pain. They may have a fever if this is caused by infection, but remember, the vast majority of these are NOT caused by infection.
We will break this down into non-infectious and infectious.
For non-infectious Post Nasal Drip, the signs are:
► The very back of the throat will be red and the surface will look rough/bumpy. You may even see some of the drip as it slides down the back of the throat. A normal throat is pink and smooth.
► A dry cough and if you listen to the lungs with a stethoscope they will be absolutely clear. There will be no rattles, crackles, gurgles, or wheeze.
Signs of infection are:
► All of the above, plus
► Swollen lymph nodes in the front part of the neck, just under the jaw. If you have fever and swollen lymph nodes, you will want to go see your provider so they can evaluate you and possibly administer antibiotics.
► The tonsils may be very red and swollen, they may even have some pus on them.
Let’s say we have evaluated the condition and we have determined this is non-infectious. We can treat this with over-the-counter medications and a lot of patience. This is not an easy thing to cure, but if you stick with what I want you to take, it will get better. I have seen this take up to three weeks before it improves and that is because we are basically trying to retrain the sinuses to not drain all the time. Some are more stubborn than others, so patience is absolutely necessary.
The key is to dry up the drip and control the symptoms while we are waiting for it to resolve.
► Loratadine 10 mg, one tablet daily. This is the generic form of Claritin and works well.
► Chlorpheniramine 4 mg/Phenylephrine 10 mg, one tablet every 4 hours. Short acting antihistamine with a decongestant.
► Flonase nasal spray or Nasacort. 2 sprays each nostril, prior to going to bed. This is to shrink the nasal tissue and also to help control the drip.
► Delsym cough syrup, 2 tsp every 12 hours. This is my absolute favorite cough medicine to shut down a cough. It is a bit more expensive, but when compared to the ones you have to take every 4 hours, this is so much better.
► Maximum strength throat lozenges, use as needed to control a sore throat.
NOTE: There are nasal sprays that contain a medication called Oxymetazoline. This can be found in products like Afrin, and other nasal sprays that are listed as “nasal decongestants.” Be very careful with this medication, as your nose can become addicted to it and you will develop a condition called Rhinitis Medicamentos. This is where your nose craves the medication and will become extremely congested until you use it again. The warning labels on the bottle will tell you to use it for no more than three days. I tell my patients to use it only when their sinuses are very tender from pressure and then stop using it as soon as that pressure has been relieved. Use this very sparingly, it you use it at all. I tend to stay away from this one.
When to go to an Urgent Care or your Family Physician
As with any condition, sometimes your condition can worsen. You can start out with a simple post nasal drip that develops into infection. Bacteria loves a warm, wet environment to proliferate and spread. This is not a common occurrence, but you should still be on the lookout for worsening symptoms.
► Wheezing: This is a sign that your lungs are deteriorating and the home treatment is not working as we hoped. You should be evaluated for possible bronchitis.
► Fever: A developing fever means infection and you should be evaluated for possible sinusitis, Strep infection, pneumonia, and ear infections