What are the treatment options for post nasal drip?

Treatment Options for Post Nasal Drip

First-line treatment for post nasal drip should include saline nasal irrigation and intranasal corticosteroids, with short-term use of first-generation antihistamine/decongestant combinations for symptomatic relief in adults and children over 6 years of age. 1

First-Line Treatments

Non-Pharmacological Approaches

• Saline nasal irrigation
  • Provides beneficial effects by improving mucous clearance
  • Enhances ciliary activity
  • Disrupts and removes antigens, biofilms, and inflammatory mediators
  • Directly protects sinonasal mucosa 1

Pharmacological Approaches

• Intranasal corticosteroids (e.g., fluticasone propionate)

  • Dosing for adults: 200 mcg daily (two 50-mcg sprays in each nostril once daily) or 100 mcg twice daily 2
  • Dosing for children (4 years and older): Start with 100 mcg daily (1 spray in each nostril once daily) 2
  • Effective for reducing total nasal symptom scores including postnasal drip 2
  • Regular use is more effective than as-needed use 2

• First-generation antihistamine/decongestant combinations

  • For short-term use only (maximum 3 weeks)
  • Not recommended for children under 6 years due to safety concerns 1
  • Effective for symptom relief but monitor for side effects (sedation, urinary retention, hypertension) 1

Second-Line Treatments

• Ipratropium bromide nasal spray

  • Consider for rhinorrhea-predominant symptoms 1
  • Particularly effective for watery postnasal drip

• Non-sedating antihistamines

  • Recommended if allergic rhinitis is suspected 1
  • Less effective for nasal congestion compared to intranasal corticosteroids

• Leukotriene receptor antagonists

  • Consider as an additional treatment option for allergic causes 1

Treatment Based on Underlying Cause

Allergic Rhinitis

• Intranasal corticosteroids + non-sedating antihistamines
• Consider allergen avoidance measures
• Leukotriene receptor antagonists may be added 1

Chronic Rhinosinusitis

• Saline irrigation + intranasal corticosteroids
• Consider short course of systemic corticosteroids for significant symptoms
• Antibiotics if bacterial infection is suspected and symptoms persist >4 weeks 1

Non-allergic Rhinitis

• Intranasal corticosteroids (100 mcg twice daily)
• Ipratropium bromide nasal spray for watery secretions 1, 2

Advanced Treatment Options

For refractory cases that fail to respond to medical therapy:

• Posterior nasal nerve (PNN) ablation
  • Recent evidence shows 72.5% of patients with primary PND symptoms reported at least 30% improvement after PNN ablation 3
  • Consider for patients who have failed medical therapy including anti-cholinergic nasal sprays, reflux treatments, and/or nasal steroids 3

Important Considerations

• Limit topical decongestants to 5-7 days maximum to prevent rhinitis medicamentosa 1
• Monitor for side effects of antihistamines and decongestants, particularly in elderly patients 1
• Ensure adequate fluid intake to maintain proper mucus consistency 1
• Consider underlying conditions that may require specific treatment:
  • Gastroesophageal reflux disease
  • Chronic sinusitis
  • Allergic rhinitis
  • Rhinitis medicamentosa 1

Treatment Duration and Monitoring

• Empiric treatment response is both diagnostic and therapeutic for PND
• If symptoms persist despite appropriate treatment for 4 weeks, consider further investigations
• Consider referral to an otolaryngologist for persistent symptoms, especially with warning signs like unilateral symptoms or bloody discharge 1

Post nasal drip treatment should be tailored based on the underlying cause and symptom severity, with regular reassessment of treatment efficacy and adjustment as needed.