What is postnasal drip?

From the Guidelines

Postnasal drip is the drainage of secretions from the nose or paranasal sinuses into the pharynx, characterized by a sensation of having something drip down into the throat, nasal discharge, or frequent throat clearing. This condition is also known as postnasal drip syndrome (PNDS) and can be caused by various factors such as rhinosinus diseases, allergies, or environmental irritants 1. The diagnosis of PNDS largely rests on the patient's reporting of symptoms, physical examination, and response to specific therapy, as there is no objective test for it.

Some key points to consider about postnasal drip include:

• The presence of mucoid or mucopurulent secretions, or cobblestoning of the mucosa in the nasopharynges or oropharynges is suggestive of PNDS 1
• The diagnosis of PNDS-induced cough is best determined by considering a combination of criteria, including symptoms, physical examination, radiographic findings, and response to specific therapy 1
• An empiric trial of therapy is both diagnostic and therapeutic, and the improvement or resolution of cough in response to specific treatment is the pivotal factor in confirming the diagnosis of PNDS as a cause of cough 1

In terms of management, treatment options may include:

• Over-the-counter antihistamines or nasal saline rinses to help alleviate symptoms
• Staying hydrated to thin out mucus and make it less noticeable
• Avoiding dairy products and alcohol, which may reduce mucus production in sensitive individuals
• Consulting a healthcare provider if symptoms persist or are accompanied by fever, severe headache, or facial pain, as prescription medications may be necessary 1

From the Research

Definition of Postnasal Drip

• Postnasal drip (PND) is a symptom that can be very irritating to both patients and doctors, characterized by an increased awareness of mucus in the back of the throat 2.
• It is a common complaint in primary care and ear-nose-throat offices, often associated with upper respiratory tract disorders, but its symptoms can be vague and variable 3, 4.
• The traditional understanding of PND is that it is caused by an increased volume of secretions moving from the posterior nasal choanae into the posterior nasopharynx/oropharynx, but this concept may be overly simplistic 3.

Pathophysiology of Postnasal Drip

• The sensation of PND may be due to mucosal inflammation resulting in heightened cough or irritant throat sensory dysfunction, rather than just increased or more viscous secretions 3.
• Studies have shown that the pathophysiology of PND related to sinonasal disease does not clearly lead to chronic cough, and that the cough from PND may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions 4.
• Altered viscosity of nasal secretions may also play a role in the sensation of PND 3.

Diagnosis and Treatment of Postnasal Drip

• There is no accepted definition or method of measurement for post-nasal drip syndrome (PNDS), making it a catch-all diagnosis for various nasal and throat-related symptoms 5.
• Investigations are aimed at trying to clearly define the cause of the increased mucus awareness, and specific treatment can be given to remedy the situation 2.
• Treatment is generally medical, but surgical treatment may be required in certain situations 2.
• Oral gargling with normal saline has been shown to be a safe and potentially effective treatment for PNDS, helping to dilute and remove mucus from the nasopharynx and oropharynx 6.