Post-Nasal Drip: Causes, Symptoms, and Treatment Options - Otolaryngology

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Post-nasal drip


Hello, doctor...
Since the beginning of January, I have been experiencing nasal congestion and post-nasal drip, with symptoms that have not improved.
The nasal discharge is clear, and I have never had this issue before.
In early April, I went to Linkou Chang Gung Memorial Hospital for a nasal endoscopy, and they diagnosed me with sinusitis and noted that I have a granuloma in my throat.
I took antibiotics for three weeks, but my nasal symptoms did not improve.
Later, the doctor performed allergy tests and found that I am allergic to dust mites.
I have been using Breathe Easy nasal spray for two months and taking antihistamines for two months as well.
I rinse my nose every morning and evening, but I still have a lot of clear nasal discharge.
My environment is clean, and I use a dust mite machine, dehumidifier, and air purifier, yet my symptoms have not improved.
Because of the granuloma in my throat, I underwent an upper gastrointestinal endoscopy at the end of April, which was normal, showing only gastroesophageal reflux.
I am currently taking acid reducers.
After a month and a half, I returned to the ENT specialist, who performed another nasal endoscopy and found that the granuloma has neither shrunk nor enlarged.
The doctor said it is mostly benign and advised me to return in three months unless it grows, in which case a biopsy would be necessary.
I would like to ask the doctor if the granuloma will disappear? If it does not disappear, will a biopsy be necessary? Is it possible that my nasal issues are related to gastroesophageal reflux? There is a theory that acid reflux can cause rhinitis; is this valid? I have excessive nasal discharge and am constantly swallowing.
What methods can help resolve this? Thank you, doctor, for your guidance.

Niming, 40~49 year old female. Ask Date: 2021/06/25

Dr. Ji Zhaoyun reply Otolaryngology


Hello, common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, although not all symptoms may appear.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists after two weeks of antibiotic treatment, it is recommended to consult an otolaryngologist for bacterial culture.
If "more virulent" bacteria are identified, a stronger antibiotic may be necessary.
It is advisable to continue using a nasal irrigator (containing isotonic saline) for 1-2 times daily to enhance the treatment of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and individuals with diabetes should control their blood sugar levels.
If sinusitis has not resolved after 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, which requires further examination, and if necessary, surgical intervention should be considered.
It is recommended to seek evaluation from an otolaryngologist.

Granulomas in the throat may indicate chronic pharyngitis, often related to gastroesophageal reflux and postnasal drip.
It is advisable to undergo laryngoscopy (to rule out masses) and receive medical treatment.
In addition to medication, daily lifestyle recommendations include avoiding lying down for two hours after eating, and avoiding coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Most masses require biopsy for definitive diagnosis through pathological reports.
If needed, further discussion with a physician is recommended.
Wishing you safety and health.

Reply Date: 2021/06/25

More Info


Post-nasal drip is a common condition that occurs when excess mucus accumulates in the back of the throat, leading to a sensation of mucus dripping down from the nasal passages. This condition can be caused by various factors, including allergies, infections, and structural issues in the nasal cavity. Understanding the causes, symptoms, and treatment options for post-nasal drip can help you manage this uncomfortable condition effectively.


Causes of Post-Nasal Drip
1. Allergies: Allergic rhinitis, often triggered by dust mites, pollen, pet dander, or mold, can lead to increased mucus production. In your case, the allergy to dust mites has been identified, which could be a significant contributor to your symptoms.

2. Infections: Viral infections, such as the common cold or sinusitis, can cause inflammation and increased mucus production. Bacterial infections can also lead to sinusitis, which may require antibiotics for treatment.

3. Structural Issues: Conditions such as a deviated septum or nasal polyps can obstruct normal mucus drainage, leading to post-nasal drip.

4. Gastroesophageal Reflux Disease (GERD): There is a connection between GERD and post-nasal drip. Stomach acid can irritate the throat and nasal passages, leading to increased mucus production and the sensation of post-nasal drip.

5. Environmental Factors: Dry air, smoke, and pollutants can irritate the nasal passages, leading to increased mucus production.


Symptoms of Post-Nasal Drip
Common symptoms associated with post-nasal drip include:
- A persistent cough, especially at night
- Sore throat or throat irritation
- Difficulty swallowing
- Bad breath
- Nasal congestion
- Sinus pressure or pain
- Nausea in some cases
In your situation, the clear nasal discharge and the sensation of mucus dripping down your throat are classic signs of post-nasal drip. The throat irritation and the need to swallow frequently can be particularly bothersome.


Treatment Options
1. Medications:
- Antihistamines: These can help reduce mucus production if allergies are the cause. Over-the-counter options like loratadine or cetirizine may be beneficial.

- Decongestants: These can help relieve nasal congestion and reduce post-nasal drip. However, they should be used cautiously and not for extended periods.

- Nasal Corticosteroids: Prescription nasal sprays can reduce inflammation in the nasal passages and help control symptoms.

- Saline Nasal Irrigation: Regularly rinsing your nasal passages with saline solution can help clear excess mucus and allergens.

2. Lifestyle Modifications:
- Avoid Allergens: Since you have a dust mite allergy, using dust mite covers on pillows and mattresses, washing bedding in hot water, and maintaining a clean environment can help.

- Stay Hydrated: Drinking plenty of fluids can thin mucus, making it easier to drain.

- Use a Humidifier: Adding moisture to the air can help soothe irritated nasal passages.

3. Addressing GERD: If your post-nasal drip is related to acid reflux, managing your diet, avoiding trigger foods, and possibly using proton pump inhibitors or H2 blockers may be necessary.


Regarding the Granuloma
Granulomas are often benign growths that can occur in response to chronic irritation or inflammation. In many cases, they may resolve on their own, but if they persist or grow, a biopsy may be warranted to rule out any serious conditions. Your ENT specialist's recommendation to monitor the granuloma is reasonable, especially if it has not changed in size.


Conclusion
Post-nasal drip can be a frustrating condition, especially when it seems resistant to treatment. Given your history of allergies and the recent findings regarding your throat, it is essential to continue working closely with your healthcare providers. They can help tailor a treatment plan that addresses both your nasal symptoms and any underlying conditions, such as GERD. If your symptoms persist or worsen, seeking further evaluation or a second opinion may be beneficial.

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