The glands in your nose and throat continually produce mucus (one to two
quarts a day). It moistens and cleans the nasal membranes, humidifies air,
traps and clears inhaled foreign matter, and fights infection. Although
mucus normally is swallowed unconsciously, the feeling that it is
accumulating in the throat or dripping from the back of your nose is called
post-nasal drip.
This feeling can be caused by excessive or thick secretions or by throat
muscle and swallowing disorders.
What Causes Abnormal Secretions – Thin and Thick
Increased thin clear secretions can be due to colds and flu,
allergies, cold temperatures, bright lights, certain foods/spices,
pregnancy, and other hormonal changes. Various drugs (including birth
control pills and high blood pressure medications) and structural
abnormalities can also produce increased secretions. These abnormalities
might include a deviated or irregular nasal septum (the cartilage and bony
dividing wall that separates the two nostrils).
Increased thick secretions in the winter often result from too
little moisture in heated buildings and homes. They can also result from
sinus or nose infections and some allergies, especially to certain foods
such as dairy products. If thin secretions become thick and green or yellow,
it is likely that a bacterial sinus infection is developing. In children,
thick secretions from one side of the nose can mean that something is stuck
in the nose (such as a bean, wadded paper, or piece of toy, etc.).
Sinuses are air-filled cavities in the skull. They drain into the
nose through small openings. Blockages in the openings from swelling due to
colds, flu, or allergies may lead to acute sinus infection. A viral "cold"
that persists for 10 days or more may have become a bacterial sinus
infection. With this infection you may notice increased post-nasal drip. If
you suspect that you have a sinus infection, you should see your physician
for antibiotic treatment.
Chronic Sinusitis occurs when sinus blockages persist and the
lining of the sinuses swell further. Polyps (growths in the nose) may
develop with chronic sinusitis. Patients with polyps tend to have
irritating, persistent post-nasal drip. Evaluation by an otolaryngologist
may include an exam of the interior of the nose with a fiberoptic scope and
CAT scan x-rays. If medication does not relieve the problem, surgery may be
recommended.
Vasomotor Rhinitis describes a nonallergic "hyperirritable nose"
that feels congested, blocked, or wet.
Swallowing Problems
Swallowing problems may result in accumulation of solids or liquids
in the throat that may complicate or feel like post-nasal drip. When the
nerve and muscle interaction in the mouth, throat, and food passage
(esophagus) aren't working properly, overflow secretions can spill into
the voice box (larynx) and breathing passages (trachea and bronchi)
causing hoarseness, throat clearing, or cough.
Several factors contribute to swallowing problems:
- With age, swallowing muscles often lose strength and
coordination. Thus, even normal secretions may not pass smoothly
into the stomach.
- During sleep, swallowing occurs much less frequently, and
secretions may gather. Coughing and vigorous throat clearing are
often needed when awakening.
- When nervous or under stress, throat muscles can
trigger spasms that feel like a lump in the throat. Frequent throat
clearing, which usually produces little or no mucus, can make the
problem worse by increasing irritation.
- Growths or swelling in the food passage can slow
or prevent the movement of liquids and/or solids.
Swallowing problems may be caused also by gastroesophageal reflux
disease (GERD). This is a return of stomach contents and acid into
the esophagus or throat. Heartburn, indigestion, and sore throat are
common symptoms. GERD may be aggravated by lying down especially
following eating. Hiatal hernia, a pouch-like tissue mass where the
esophagus meets the stomach, often contributes to the reflux.
Chronic Sore Throat
Post-nasal drip often leads to a sore, irritated throat. Although there
is usually no infection, the tonsils and other tissues in the throat may
swell. This can cause discomfort or a feeling of a lump in the throat.
Successful treatment of the post-nasal drip will usually clear up these
throat symptoms.
Treatment For Post-Nasal Drip
A correct diagnosis requires a detailed ear, nose, and throat exam
and possible laboratory, endoscopic, and x-ray studies. Each treatment
is different:
Bacterial infection, when present, is treated with
antibiotics. These drugs may provide only temporary relief. In cases of
chronic sinusitis, surgery to open the blocked sinuses may be required.
Allergy is managed by avoiding the cause if possible.
Antihistamines and decongestants, cromolyn and steroid (cortisone type)
nasal sprays, and other forms of steroids may offer relief.
Immunotherapy (allergy shots) also may be helpful. However, some older,
sedating antihistamines may dry and thicken post-nasal secretions even
more; newer nonsedating antihistamines, available by prescription only,
do not have this effect. Decongestants can aggravate high blood
pressure, heart, and thyroid disease. Steroid sprays generally may be
used safely under medical supervision. Oral and injectable steroids
rarely produce serious complications in short-term use. Because
significant side-effects can occur, steroids must be monitored carefully
when used for more than one week.
Gastroesophageal reflux is treated by elevating the head of
the bed six to eight inches, avoiding foods and beverages for two to
three hours before bedtime, and eliminating alcohol and caffeine from
the daily diet. Antacids (e.g., Maalox®, Mylanta®, Gaviscon ®) and drugs
that block stomach acid production (e.g., Zantac®, Tagamet®, Pepcid®) or
more powerful medications may be prescribed. A trial treatment may be
suggested before x-rays and other diagnostic studies are performed.
General measures for thinning secretions so they can pass more
easily may be recommended when it is not possible to determine whether
an existing structural abnormality is causing the post-nasal drip or if
some other condition is to blame.
Many people, especially older persons, need more fluids to thin
secretions. Drinking more water, eliminating caffeine, and avoiding
diuretics (fluid pills) will help. Mucous-thinning agents such as
guaifenesin (Humibid®, Robitussin®) may also thin secretions.
Nasal irrigations may alleviate thickened secretions. These can be
performed two to four times a day either with a nasal douche device or a
Water Pik® with a nasal irrigation nozzle. Warm water with baking soda
or salt (1/2 to 1 tsp. to the pint) or Alkalol®, a nonprescription
irrigating solution (full strength or diluted by half warm water), may
be helpful. Finally, use of simple saline (salt) nonprescription nasal
sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very
beneficial.