From the Guidelines
Postnasal drip (PND) 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, as defined by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.
Definition and Diagnosis
The diagnosis of PND syndrome (PNDS) largely rests on the patient's reporting of symptoms, including the sensation of postnasal drip, nasal discharge, or frequent throat clearing, as well as the presence of mucoid or mucopurulent secretions, or cobblestoning of the mucosa on examination of the nasopharynges or oropharynges 1.
Causes and Symptoms
Common causes of PND include allergies, sinus infections, colds, flu, certain medications, and environmental irritants, leading to symptoms such as a constant need to clear the throat, coughing (especially at night), sore or scratchy throat, and sometimes bad breath.
Management and Treatment
To manage PND, an empiric trial of therapy is both diagnostic and therapeutic, and may include over-the-counter antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) for allergy-related cases, or decongestants like pseudoephedrine for short-term relief, as well as nasal saline sprays or rinses to thin mucus and flush irritants 1. Staying hydrated, using a humidifier, and avoiding known triggers are also effective strategies. If symptoms persist beyond 10 days or are accompanied by fever, severe headache, or facial pain, it is recommended to see a doctor as these may indicate a bacterial infection requiring antibiotics or a more serious underlying condition.
From the Research
Definition and Causes of Postnasal Drip (PND)
- Postnasal drip (PND), also known as upper airway secretion, is a common clinical complaint that may be caused by a variety of conditions involving the nose and throat 2.
- The symptom of PND is not always caused by actual secretions draining from the nose into the pharynx, and in many instances, no definitive cause can be identified 2.
- PND can be associated with altered viscosity of nasal secretions, and the sensation of PND may be due to mucosal inflammation resulting in heightened cough or irritant throat sensory dysfunction 3.
Pathophysiology and Mechanisms of PND
- The traditional pathophysiology of PND related to sinonasal disease does not clearly lead to chronic cough, and the cough from PND may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions 4.
- The mechanisms of PND in chronic patients and those with rhinitis are likely to have other aetiologies other than simply increased or more viscous secretions 3.
- Studies have shown that PND is a complex symptom that lacks objective testing and its symptoms can be vague and variable, making it a catch-all diagnosis for a variety of nasal and throat-related symptoms 4, 5.
Diagnosis and Management of PND
- Empiric treatment for PND symptoms should be guided by associated symptoms that suggest either a sinonasal cause or gastroesophageal reflux 2.
- Investigations are aimed at trying to clearly define the cause of the increased mucus and then specific treatment can be given to remedy the situation 6.
- Treatment is generally medical, however, surgical treatment is required in certain situations 6.
- Referral to an otolaryngologist is appropriate if symptoms are persistent, unexplainable, or associated with warning signs of malignancy 2.