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

Post-nasal drip with throat itching and difficulty breathing?

Hello Doctor, I have been experiencing post-nasal drip, a scratchy throat with a sensation of foreign body, difficulty breathing, and chest tightness for nearly four months, and medication has not alleviated these symptoms.
During this time, I consulted two ENT specialists; one believed it to be seasonal allergies, while the other thought it was due to turbinate hypertrophy and recommended laser surgery.
Both doctors conducted visual examinations and auscultation without any additional tests.
My concern is that I do not have a long-term nasal congestion issue; my nose is usually clear.
The scratchy throat and sensation of foreign body, along with post-nasal drip, are persistent, while the chest tightness occurs intermittently each week.
Do you think laser surgery is necessary in this case? I am worried that the symptoms may not primarily be due to turbinate hypertrophy, and undergoing surgery hastily could lead to adverse side effects.
Thank you for your response.

A Yu, 20~29 year old female. Ask Date: 2022/11/24

Dr. Ji Zhaoyun reply Otolaryngology

Regarding allergic rhinitis, there are several important concepts: the individual's constitution and environmental allergens and irritants are the main triggering factors.
If one parent has allergic rhinitis, the likelihood of their children developing allergic rhinitis is four times higher.
The most common allergen is dust mites, followed by animals, insects, mold, and pollen.
Recently recognized fine particulate matter (PM2.5) is also an important irritant.

Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The primary medications include oral antihistamines and intranasal corticosteroid sprays, often used in combination.
Depending on the situation, local antihistamines/vasoconstrictors or oral leukotriene receptor antagonists may also be utilized.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, enlarged inferior turbinates, or nasal valve narrowing, appropriate surgical intervention can be performed.
Recently, minimally invasive surgical techniques have been developed, which require shorter operation times and do not necessitate hospitalization, making them widely applicable.
To avoid allergens and reduce irritants, wearing masks, maintaining a clean home environment, regularly washing bedding, avoiding extreme temperature and humidity changes, and reducing outdoor activities during severe PM2.5 air pollution are key points for daily care.
Although allergic rhinitis can be bothersome, with appropriate medications or combined surgical options, and by minimizing exposure to allergens and irritants, it can be well-controlled, significantly improving quality of life and enhancing performance in academics and work.
The text mentions that during the consultation, two otolaryngologists conducted visual and auditory examinations without further assessments.
It is recommended to visit an otolaryngologist in person for a more thorough examination.
Wishing you peace and health.

Reply Date: 2022/11/24

More Info

Post-nasal drip is a common condition that occurs when excess mucus accumulates in the back of the throat. This can lead to a variety of symptoms, including throat irritation, a sensation of a lump in the throat, coughing, and difficulty breathing. Understanding the symptoms, causes, and treatment options for post-nasal drip is crucial for effective management.

Symptoms of Post-Nasal Drip
The symptoms of post-nasal drip can vary from person to person but often include:
1. Throat Irritation: A persistent scratchy or sore throat due to mucus dripping down the back of the throat.

2. Coughing: This can be worse at night or when lying down, as gravity allows mucus to pool.

3. Feeling of a Lump in the Throat: Many individuals report a sensation of something stuck in their throat.

4. Bad Breath: Mucus can contribute to halitosis.

5. Nasal Congestion: Although you mentioned not having long-term nasal congestion, many people experience some degree of nasal blockage.

6. Chest Discomfort: This can manifest as a feeling of tightness or pressure in the chest.

Causes of Post-Nasal Drip
Several factors can contribute to post-nasal drip, including:
1. Allergies: Seasonal or perennial allergies can lead to increased mucus production.

2. Infections: Viral infections like the common cold or bacterial infections such as sinusitis can cause post-nasal drip.

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

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

5. Gastroesophageal Reflux Disease (GERD): Acid reflux can irritate the throat and lead to post-nasal drip symptoms.

Treatment Options
Given your symptoms have persisted for four months without relief from medication, it’s essential to explore various treatment options:
1. Medications: Antihistamines can help if allergies are the cause. Nasal corticosteroids can reduce inflammation in the nasal passages. Decongestants may also provide temporary relief.

2. Saline Nasal Irrigation: Using a saline solution to rinse the nasal passages can help clear mucus and allergens.

3. Avoiding Triggers: Identifying and avoiding allergens or irritants can significantly reduce symptoms.

4. Lifestyle Modifications: Staying hydrated, using a humidifier, and avoiding smoking can help manage symptoms.

5. Surgery: If structural issues like nasal polyps or severe nasal obstruction are identified, surgical options such as laser surgery may be considered. However, surgery should be a last resort after conservative treatments have failed.

Concerns About Surgery
Your concerns regarding the necessity of laser surgery are valid. If you do not have significant nasal obstruction or if your symptoms are primarily related to post-nasal drip without clear structural issues, it may be prudent to seek a second opinion or further evaluation. A thorough examination, possibly including imaging studies like a CT scan, can provide more insight into the underlying causes of your symptoms.

Conclusion
In summary, post-nasal drip can be a frustrating condition, especially when symptoms persist despite treatment. It is essential to work closely with your healthcare provider to determine the most appropriate course of action. If you feel uncertain about the recommendations for surgery, consider discussing your concerns with your doctor or seeking a referral to an otolaryngologist (ENT specialist) for a more comprehensive evaluation. This approach can help ensure that any treatment plan is tailored to your specific needs and symptoms, minimizing the risk of unnecessary procedures.

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