Post-Nasal Drip: Causes and Solutions for Sinusitis

Sinusitis with post-nasal drip

Hello, Doctor.
In April, I underwent an endoscopic examination for sinusitis, which revealed a staphylococcal infection through bacterial culture.
I took Montelukast for two weeks and returned for a follow-up at the end of April.
The doctor said I was 90% better and did not prescribe any more medication.
However, I still experience nasal discharge, which I can only blow out and does not postnasally drip.
By June, the postnasal drip became severe again, and upon returning to the doctor, I was diagnosed with sinusitis once more.
The doctor prescribed Montelukast again, and I have been taking it for 10 days with no improvement in symptoms.
The doctor tested for allergens and confirmed a dust mite allergy, advising me to disinfect my nasal irrigation device and maintain a clean environment.
Although I have implemented these recommendations, there has been little improvement.
My nasal discharge is consistently clear but very thick, causing discomfort due to postnasal drip.
The discharge from nasal irrigation is also very thick.
I have a history of gastroesophageal reflux and am taking antacids.
I rinse my nasal passages morning and night, but about 2-3 hours after rinsing, I noticeably feel postnasal drip again.
Could you please advise what might be causing my current symptoms? Thank you.

Niming, 40~49 year old female. Ask Date: 2021/07/08

Dr. Zheng Jueyi reply Otolaryngology

Hello, if there is no obvious yellow or green nasal discharge, it is commonly associated with allergic rhinitis or chronic rhinitis.
Continuous nasal irrigation may be beneficial.
If symptoms persist and interfere with daily life, it is recommended to consult an otolaryngologist to evaluate the need for oral medications or nasal sprays.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/08

More Info

Post-nasal drip is a common condition that occurs when excess mucus accumulates in the back of the throat, often leading to discomfort and a range of symptoms. In your case, it appears that you have a history of sinusitis, which can significantly contribute to the symptoms you are experiencing. Let's delve into the potential causes and solutions for your situation.

Causes of Post-Nasal Drip
1. Sinusitis: Chronic sinusitis can lead to persistent inflammation of the nasal passages and sinuses, causing the production of thick mucus. This mucus can accumulate and drip down the back of the throat, leading to irritation and discomfort.

2. Allergies: Allergic reactions to dust mites, pollen, pet dander, or other allergens can cause the nasal passages to become inflamed, resulting in increased mucus production. Your mention of dust mite allergies suggests that this could be a contributing factor.

3. Gastroesophageal Reflux Disease (GERD): Since you have a history of acid reflux, it’s possible that stomach acid is irritating your throat and nasal passages, leading to increased mucus production and post-nasal drip.

4. Environmental Factors: Dry air, pollution, and irritants can exacerbate nasal congestion and mucus production. Ensuring a clean and well-humidified environment can help alleviate symptoms.

5. Infections: Bacterial or viral infections can lead to increased mucus production. The presence of Staphylococcus aureus in your bacterial culture indicates a possible infection that may need further treatment.

Solutions and Management Strategies
1. Medications: Since you have been prescribed medications like Montelukast (孟克杏), it’s important to continue following your doctor’s advice. If symptoms persist, discussing alternative medications or dosages with your healthcare provider may be necessary. Consider discussing the use of nasal corticosteroids, which can help reduce inflammation in the nasal passages.

2. Nasal Irrigation: Regular nasal irrigation with saline solutions can help clear mucus and allergens from the nasal passages. Ensure that your irrigation device is properly sanitized to prevent introducing new irritants.

3. Allergy Management: Since you have identified dust mites as an allergen, consider implementing measures to reduce exposure, such as using allergen-proof bedding, washing linens in hot water, and using a HEPA filter in your home.

4. Diet and Lifestyle Changes: If GERD is contributing to your symptoms, dietary modifications may be beneficial. Avoiding spicy foods, caffeine, and large meals before bedtime can help reduce acid reflux symptoms.

5. Hydration: Staying well-hydrated can thin mucus, making it easier to expel. Aim to drink plenty of fluids throughout the day.

6. Follow-Up Care: Since your symptoms have not improved significantly, it may be worthwhile to seek a second opinion or further evaluation from an ENT specialist. They may recommend imaging studies, such as a CT scan, to assess the sinuses more thoroughly.

7. Consider Other Conditions: If post-nasal drip persists despite treatment, it may be worth exploring other potential underlying conditions, such as nasal polyps or structural issues in the nasal passages.

In summary, post-nasal drip can be a multifactorial issue, particularly in the context of chronic sinusitis and allergies. A comprehensive approach that includes medication, lifestyle changes, and regular follow-up with your healthcare provider can help manage your symptoms effectively. If you continue to experience discomfort, do not hesitate to reach out for further evaluation and tailored treatment options.

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