Post Nasal Drip and Chronic Sinusitis: A Clear Connection
Yes, post nasal drip is directly related to chronic sinusitis and is one of the primary manifestations of this condition. 1 Chronic sinusitis can cause post nasal drip through inflammation and excessive mucus production in the sinuses that drains into the throat.
Understanding the Relationship
- Post nasal drip (PND) is now preferably termed Upper Airway Cough Syndrome (UACS) by medical experts 1, 2
- Chronic sinusitis is one of the most common causes of post nasal drip, accounting for approximately 31% of PND cases 3
- UACS secondary to various rhinosinus conditions, including chronic sinusitis, is the most common cause of chronic cough in adults 1, 2
- The drainage of secretions from the sinuses into the pharynx creates the sensation of post nasal drip 2
Clinical Presentation
- Chronic sinusitis may cause a productive cough with post nasal drip, but can also be "clinically silent" where the cough is relatively or completely nonproductive 1
- Patients may present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, post nasal drip, ear pain, and fatigue 4
- The symptoms and signs of post nasal drip are nonspecific, making definitive diagnosis challenging based solely on history and physical examination 1
- Some patients may have "silent" post nasal drip with no obvious symptoms yet still respond to treatment for sinusitis 2
Diagnostic Considerations
- Sinus imaging (radiographs or CT scans) can detect changes suggestive of chronic sinusitis, but this doesn't automatically confirm that post nasal drip is caused by the sinus disease 1
- In patients with chronic cough and excess sputum production, sinus radiographs have a positive predictive value of 81% and negative predictive value of 95% for predicting that chronic sinusitis was responsible for the UACS-induced cough 1
- For patients with chronic cough without excess sputum production, these values are 57% and 100%, respectively 1
- Fiberoptic nasopharyngoscopy can help identify the source of sinus discharge and cause of obstruction 4
Common Pitfalls and Caveats
- Failure to consider "silent" UACS as a causative factor for chronic cough can lead to missed diagnoses 2
- Post nasal drip can sometimes be confused with other conditions like gastroesophageal reflux disease (GERD) 2
- Not all mucosal thickening on imaging indicates bacterial infection; one study showed that <8mm of mucosal thickening was associated with sterile nasal puncture in 100% of cases 1
- In patients with chronic cough, antibiotic therapy was needed for resolution in only 29% of cases where the only abnormality was mucosal thickening 1
Treatment Approach
- First-line therapy for chronic sinusitis with post nasal drip typically includes:
- For bacterial sinusitis, appropriate antibiotics may include amoxicillin/clavulanic acid, ciprofloxacin, clarithromycin, or trimethoprim/sulfamethoxazole 5
- In recalcitrant cases not responding to medical therapy, functional endoscopic sinus surgery (FESS) may be necessary 6
- FESS has shown significant improvement in both post nasal drip and cough symptoms in patients with chronic sinusitis 6
Understanding the clear relationship between chronic sinusitis and post nasal drip is essential for proper diagnosis and effective treatment of this common condition.