Finding Relief From Post-Nasal Drip.

The season of allergies and colds is upon us and, with it, the all-too-familiar runny nose and its frequent companion, post-nasal drip. And adding an extra level of caution this year is the spread of COVID-19, which can cause symptoms similar to post-nasal drip at its onset.

Let’s review a few facts behind post-nasal drip: what it is, what causes it, and what we can do about it.

Why does mucus form? Mucus actually serves a healthy purpose. The glands within your sinus cavities produce it in order to trap foreign particles, eliminate debris from the sinuses, and help humidify the air you breathe.

Typically, debris cleared from the nose is pushed into the nasopharynx, then into the back of your mouth as post-nasal drip, which you swallow like saliva. In general, this process is routine and beneficial. But it can become an issue when mucus secretion becomes excessive and causes serious nasal congestion or an irritated throat.

Post-nasal drip can result from many factors, most of them not a serious threat to your health. The most common causes are allergies that cause inflammation or swelling of the lining of the nose, spurring overproduction of mucus.

When this excess mucus is persistent—or if its thickness and frequency cause that constant drip in your throat—you may begin to experience additional symptoms, like an itchy throat, hoarseness, and the need to clear your throat constantly.

In addition to allergies, here are some other factors that may cause or aggravate your post-nasal drip:

• Dehydration: Breathing a lot of dry air—very common when the heater goes on in the wintertime— can dehydrate the nasal passages or cause increased production of mucus. Being dehydrated can also cause the mucus that’s produced to be thicker.
• Environmental conditions: Depending on the individual, the lining of the nose can be sensitive to changes in temperature, wind, and humidity. Fluctuations may affect when and how the nose produces mucus.
• Seasonality: Some people are more affected in the spring if they’re allergic to tree pollen or in the fall if they’re allergic to weeds in bloom. Some suffer more in cooler, drier months, or get more sinus infections in winter. Every nose is different.
• Sinus issues: Sinusitis, a sinus infection, or a structural problem with the nose that affects airflow (such as a deviated nasal septum) can cause swelling or edema of the nasal lining, and lead to more mucus production and more post-nasal drip.
• Acid reflux: When acids rise from the stomach into the throat (especially after you eat spicy foods, large quantities of food, and/or greasy foods) your esophagus, the back of your throat, and even your nose may become irritated. Because the lining of the nose is not suited for exposure to such irritants, you may find that more mucus is produced, leading to post-nasal drip.
• Age: Older patients are more prone to dehydration and have slightly thicker nasal secretions and drier nasal cavities, often spurring intermittent hoarseness, frequent throat clearing and chronic cough.
• Smoking: A larger percentage of smokers tend to have post-nasal drip. Cilia—small hairs in the lining of the nose—propel mucus toward the back of the nose to clear it. Smoking can stunt the cilia’s ability to do their job, so secretions may become very thick and arrive at the back of the throat as post-nasal drip.

When to Consult a Specialist

If your post-nasal drip is a byproduct of a common cold and resolves on its own, it’s not likely to be concerning. But if it persists for more than two weeks, consider being evaluated by a doctor who can help you feel more comfortable.

You should schedule an exam if:

• Your post-nasal drip is accompanied by persistent dripping outside your nose as well
• Your nasal passages have been stuffy for some time, especially on one side of the nose
• Your post-nasal drip comes with chronic hoarseness or cough that’s been present for 3-4 weeks or may be worsening
• Your excess mucus looks discolored or bloody, has a bad odor, or is accompanied by a fever

At MedStar Washington Hospital Center, it’s very common for us to see these issues in patients with sinus or allergic rhinitis symptoms, and most of these issues are related to inflammation in the nose. But there could be other underlying reasons as well.

Rinses and Sprays Can Help

There are a number of ways to thin mucus, help the nose drain more efficiently, and prevent infections. Rinsing aids such as NeilMed® Sinus Rinse, neti pots, or Navage® can be used to beneficially irrigate the lining of your nose. The irrigation products come with little pre-made salt packets; you can add either distilled water or boiled tap water that you’ve let cool first.

Mist sprays can also help, although they are typically not as effective as a rinse. The mist sprays function to help moisturize the nasal passages but may not be as effective in clearing the mucus secretions and getting into the sinuses.

In addition to recommending a rinse or spray product, I typically prescribe Flonase®, azelastine, Atrovent®, or some combination. For people with posterior drip and sinus issues, these sprays can be very helpful. Continued use can help keep inflammation down and decrease mucus production to keep the nasal drip under control. And you don’t necessarily have to use these medications indefinitely. After we control the symptoms, we can start to decrease medications while continuing to observe how you’re doing.

Can home remedies also help? Sometimes. “Non-drowsy” antihistamines, saline sprays, sleeping with your head elevated, using a humidifier, and drinking chicken soup and other hot liquids can work to thin mucus a bit. Avoiding cigarette smoke can help as well (and benefits your health in other ways).

Is Post-Nasal Drip Curable?

Unfortunately, no. So far, we can’t cure inflammation in the nose, only manage it by using the sprays and rinses. But it’s crucial to be consistent with their use and to discontinue them gradually and systematically. Stopping them prematurely may allow inflammation to return.

If your nasal secretions are thin, white, and watery, you are generally OK unless they’re persistent. If you develop frequent or thick, yellowish, green, or other colored mucus, if it has a foul odor, if you feel facial pressure and pain, or if you experience a change in your sense of smell, seek medical care.

Besides ongoing post-nasal drip, persistent or chronic throat irritation, voice irritation, nasal congestion, stuffiness, or difficulty breathing through the nose should be addressed before they potentially lead to other symptoms. For example, when you have difficulty breathing through your nose, you often end up breathing through the mouth, which can put you at a higher risk for sleep apnea and sleep disturbances.

If you have the severe, progressive or persistent symptoms of post-nasal drip that I’ve described, I encourage you to work with a doctor, track your symptoms, and use your prescribed treatments regularly.

What to Expect from an Examination?

Post-nasal drip is so common that general practitioners and family medicine doctors see it much more frequently in their offices than we do, and they typically refer patients to us when they display symptoms that are persistent and not improving.

When you come to MedStar Washington Hospital Center, we provide you with a comprehensive evaluation, as well as care that’s both empathetic and thorough. Throughout our department, my colleagues and I take pride in listening to our patients and developing a plan that works to control and improve your symptoms.

We’re a collegial and collaborative team, experienced with disorders ranging from the benign to the most complex and critical. We stay up-to-date with the latest treatment options related to medical therapies, surgical therapies, and procedures to mitigate your symptoms and underlying problems.

We like to see you in person for a physical examination of the nose and nasal lining, either via endoscopy or anterior rhinoscopy, to observe how the mucus is draining from the sinuses. A quick look at the back of the throat can help us note any thick secretions, irritation, or inflammation, and determine an appropriate treatment.

In a small amount of cases, we may find that a situation is more complex—for example:

• Allergic rhinitis with turbinate hypertrophy which can cause nasal obstruction
• A septal deviation that’s aggravating the symptoms, and the patient is not improving on sprays
• Nasal congestion or obstruction that can be improved by fixing the structures

If the issue is sinus-related, we may recommend sinus surgery to bring relief.

Remember: It’s not necessary to tolerate chronic post-nasal drip symptoms and related complications that could be affecting your quality of life. We have options that can alleviate your discomfort.