From the Guidelines
Chronic postnasal drip is best managed through a combination of nasal saline irrigation, intranasal corticosteroids, and antihistamines, as recommended by recent guidelines 1.
Management of Chronic Postnasal Drip
To manage chronic postnasal drip, start with daily saline rinses using a neti pot or squeeze bottle with sterile saline solution to flush mucus and irritants from the nasal passages.
- Add an intranasal corticosteroid spray like fluticasone (Flonase) or mometasone (Nasonex), using 1-2 sprays in each nostril once daily.
- For allergic causes, add a non-sedating antihistamine such as loratadine (10mg daily), cetirizine (10mg daily), or fexofenadine (180mg daily) as suggested by 1.
Additional Measures
If symptoms persist after 2-4 weeks, consider adding ipratropium bromide nasal spray (0.03%, 2 sprays each nostril 2-3 times daily) to reduce mucus production.
- Lifestyle modifications are also important: stay hydrated (8 glasses of water daily), use a humidifier in dry environments, avoid known allergens, quit smoking, and elevate the head of your bed by 30 degrees when sleeping.
Underlying Conditions
Chronic postnasal drip occurs when excess mucus accumulates in the back of the throat due to allergies, sinus infections, or environmental irritants, causing the sensation of mucus dripping down the throat, throat clearing, cough, and sometimes hoarseness 1.
- If symptoms don't improve with these measures after 4-6 weeks, consult a healthcare provider as you may need evaluation for underlying conditions like chronic sinusitis or gastroesophageal reflux disease.
From the Research
Chronic Postnasal Drip
- Chronic postnasal drip is a common clinical complaint that may be caused by various conditions involving the nose and throat 2
- The symptom 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
- Empiric treatment for postnasal drip symptoms should be guided by associated symptoms that suggest either a sinonasal cause or gastroesophageal reflux 2
Treatment Options
- Azelastine nasal spray and fluticasone nasal spray in combination may provide a substantial therapeutic benefit for patients with seasonal allergic rhinitis compared with therapy with either agent alone 3
- Intranasal azelastine and intranasal fluticasone propionate have comparable efficacy in symptom control in moderate-to-severe seasonal allergic rhinitis 4
- A fixed-dose combination of intranasal azelastine hydrochloride and fluticasone propionate has a rapid onset of action and is more effective than oral loratadine and intranasal fluticasone propionate in reducing nasal symptoms 5
Related Conditions
- Chronic cough is a multifactorial symptom that requires a multidisciplinary approach, and gastroesophageal reflux and postnasal drip syndrome are common causes of chronic cough 6
- The otolaryngologist plays a pivotal role in managing chronic cough patients, and multidisciplinary assessment can help deal with these cases confidently in one-stop clinics 6