Post-Nasal Drip: Causes, Symptoms, and When to Seek Help

Throat discomfort with post-nasal drip?

Hello, doctor.
Recently, I experienced a sore throat with some slight blood in my phlegm.
After examination, the doctor diagnosed me with acute pharyngitis.
Due to the inflammation, he did not perform a nasal endoscopy at that time.
During my follow-up visit, the doctor conducted the endoscopy and found that I have large nasal polyps, a deviated septum, and severe post-nasal drip.
I often feel dryness and a sensation of something stuck in my throat.
After taking medication, my condition improved, and there was no more blood.
However, today I coughed up phlegm that had a noticeable metallic taste of blood, and the phlegm appeared slightly red, but it returned to normal afterward.
I would like to know if post-nasal drip can sometimes cause phlegm to appear red or have blood in it (though not in large amounts).
Additionally, why does post-nasal drip feel particularly bothersome when swallowing pills or after eating, even though my swallowing function is normal and I can eat and drink without issues? Should I consult another doctor? Is there a high chance that a nasal endoscopy would miss nasopharyngeal or hypopharyngeal cancer? I am concerned that the doctor may not have seen or paid attention to something important.
Sorry for bothering you.

Huang, 30~39 year old female. Ask Date: 2021/09/11

Dr. Ji Zhaoyun reply Otolaryngology

Hello, most cases of nasopharyngeal cancer or hypopharyngeal cancer can be detected through nasopharyngolaryngoscopy.
However, sometimes subtle ulcers, leukoplakia, or swollen lesions may be benign, precancerous changes, or early-stage cancer, making it difficult to determine.
Regular follow-up is recommended, and if symptoms persist, it is advisable to seek medical attention.

Reply Date: 2021/09/11

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 various symptoms. Understanding its causes, symptoms, and when to seek medical help is crucial for effective management.

Causes of Post-Nasal Drip
Post-nasal drip can be caused by several factors, including:
1. Allergies: Allergic rhinitis can lead to increased mucus production, causing it to drip down the throat.

2. Infections: Viral infections, such as the common cold or sinusitis, can cause inflammation and increased mucus production.

3. Structural Issues: Conditions like a deviated septum or nasal polyps can obstruct normal mucus drainage, leading to accumulation.

4. Environmental Irritants: Smoke, pollution, and strong odors can irritate the nasal passages, causing increased mucus production.

5. Gastroesophageal Reflux Disease (GERD): Acid reflux can irritate the throat and lead to mucus accumulation.

Symptoms of Post-Nasal Drip
Common symptoms associated with post-nasal drip include:
- A sensation of mucus dripping down the throat
- Frequent throat clearing
- Coughing, especially at night
- Sore throat or irritation
- Bad breath
- Difficulty swallowing or a feeling of something stuck in the throat
In your case, the presence of blood in the sputum, even if it is not consistent, can be concerning. While post-nasal drip can sometimes cause minor irritation that may lead to blood-tinged mucus, it is essential to monitor this symptom closely. Blood in sputum can also indicate other conditions, such as infections, inflammation, or more serious issues like malignancies.

When to Seek Help
You should consider seeking medical attention if you experience any of the following:
- Persistent or worsening symptoms despite treatment
- Significant amounts of blood in your sputum
- Symptoms that are accompanied by fever, chills, or weight loss
- Difficulty breathing or swallowing
- A feeling of a lump in your throat that does not improve
Given your history of acute pharyngitis and the recent findings of nasal polyps and a deviated septum, it is advisable to follow up with an ENT specialist. They can perform a thorough examination, including a nasal endoscopy, to assess the extent of your nasal issues and determine if they are contributing to your symptoms.

Concerns About Cancer
Your worry about the possibility of nasopharyngeal or oropharyngeal cancer is understandable, especially with symptoms like blood-tinged sputum. While nasal endoscopy is a valuable tool for diagnosing various conditions, no test is perfect. If you have concerns about the thoroughness of your examination or if your symptoms persist or worsen, seeking a second opinion is a reasonable course of action. It is essential to communicate your concerns with your healthcare provider, as they can guide you on the next steps and possibly recommend further imaging or biopsies if necessary.

Conclusion
In summary, post-nasal drip can result from various causes, and while it can lead to discomfort and irritation, it is essential to monitor your symptoms closely. Given your recent health history and the presence of blood in your sputum, it would be prudent to follow up with your healthcare provider or seek a second opinion to ensure that any underlying issues are adequately addressed. Early intervention can lead to better outcomes and peace of mind.

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