From the Guidelines
Post-nasal drip can be effectively managed through a combination of medications and lifestyle modifications, with the most recent and highest quality evidence recommending saline nasal irrigation and nasal corticosteroids as first-line treatments. According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1, nasal corticosteroids are effective in reducing total symptom score in adults suffering from acute post-viral rhinosinusitis, although the effect is small.
Workup
The diagnosis of postnasal drip syndrome (PNDS) largely rests on the reporting of the patient of this sensation of having something drip down into the throat, 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.
Treatment
Start with saline nasal irrigation using a neti pot or squeeze bottle twice daily to flush out mucus and irritants. For symptomatic relief, try an over-the-counter antihistamine like loratadine (10mg daily) or cetirizine (10mg daily) if allergies are suspected. Nasal steroid sprays such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) can reduce inflammation and mucus production; these typically take 1-2 weeks for full effect and should be used consistently.
Some key points to consider:
- Antibiotics are not recommended for post-viral rhinosinusitis in adults, as they have no benefit on cure or duration of disease and may cause adverse events 1.
- Systemic corticosteroids are also not recommended, as they have a small but significant effect on facial pain at days 4-7 after start of treatment, but no positive effect on recovery at 7-14 days, and may cause harm 1.
- Decongestants, nasal irrigation with saline, homeopathy, and herbal medicine may be considered, but the evidence is limited or of low quality, and no strong advice can be given 1.
Lifestyle Modifications
Environmental modifications are also important:
- Use a humidifier in dry environments
- Stay well-hydrated with 64+ ounces of water daily
- Avoid known allergens
- Elevate your head while sleeping
- Avoid irritants like smoke and strong fragrances
If symptoms persist beyond 2-3 weeks despite these measures, or if you develop fever, facial pain, or colored discharge, consult a healthcare provider as these may indicate sinusitis or another condition requiring antibiotics or further evaluation.
From the Research
Workup for Postnasal Drip (PND)
- The workup for PND involves understanding the pathophysiology of the condition and identifying the causes of increased mucus awareness 2
- Investigations are aimed at clearly defining the cause of the increased mucus, which can include pulmonary function tests, CT of the paranasal sinuses and chest, carbachol provocation test, fiberoptic rhinoscopy, fiberoptic bronchoscopy, and 24-h esophageal pH monitoring 3
- The presence of blood-tinged post-nasal drip can prompt suspicion of malignancy or other conditions, and its significance should be evaluated in the context of paranasal sinus disease 4
Treatment for Postnasal Drip (PND)
- Treatment for PND is generally medical, but surgical treatment may be required in certain situations 2
- First-generation antihistamine-decongestant therapy can be effective in treating chronic idiopathic postnasal drip, with 71.6% of patients responding positively to this treatment 5
- However, symptom re-occurrence can occur in some patients, particularly those with nasal stiffness or persistent symptoms 5
- The management of PND may also involve addressing underlying conditions such as asthma, gastroesophageal reflux disease, and sinonasal disease, which can contribute to chronic cough and other symptoms 6, 3
- A pathogenic triad of chronic cough, including asthma, postnasal drip syndrome, and gastroesophageal reflux disease, should be considered in the evaluation and treatment of PND 3