Post-nasal drip

Post-nasal drip
Post-nasal drip
Specialty Otorhinolaryngology

Post-nasal drip (PND, also termed upper airway cough syndrome, UACS, or post nasal drip syndrome, PNDS) occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose and eventually the throat once it drips down the back of the throat.[1] It is caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing (such as an esophageal motility disorder). But also further sources such as an allergy, cold or flu and as a result of medications.[2]

However, researchers argue that the flow of mucus down the back of the throat from the nasal cavity is a normal physiologic process that occurs in all healthy individuals.[3] Post-nasal drip has been challenged as a syndrome and instead is widely viewed as a symptom by various researchers as a result of the wide variation amongst differing societies. Furthermore this rebuttal is reinforced due to the lack of an accepted definition, pathologic tissue changes, and available biochemical tests.[3]

Presentation

Associated conditions

PND may present itself through the constant presence of discomfort within an individual's upper airways as a result of the transportation of mucus from nasal membranes down the back of the throat consequently triggering a cough which becomes more pronounced in some cases due to heightened response to various infections.[4]

GERD is often associated with a high prevalence of upper respiratory symptoms similar to PNDS such as coughing, throat clearing, hoarseness and change in voice. Reflux causes throat irritation, leading to a sensation of increased mucus in the throat which is believed to aggravate and in some cases cause post-nasal drip.[5] [6]

Many suggest post-nasal drip to be a contributing factor in the causation of extra-oral halitosis (Bad breath). However Erin O'Brien, M.D. of Otorhinolaryngology at the Mayo Clinic states this is not always the case as mucus is odourless. Though there may be an increased risk of short-lived bad breath when a sinus infection is present.[6]

Post-nasal drip can be a cause of laryngeal inflammation and hyperresponsiveness, leading to symptoms of vocal cord dysfunction (VCD).[7][8]

Diagnosis

A prolonged period of examination which bases itself on information gathered from the patient themselves, regarding the chronology of the dripping sensation in the throat, evident within PND can be unreliable and biased in diagnosing the syndrome itself with the absence of any accurate and objective diagnostic tests. As such suggestive procedures which highlights rhinitis and mucopurulent secretions such as a Nasoendoscopy may be utilised instead due to the vague nature of information present to directly attribute specific symptoms to the syndrome.[9][10]

Treatment

Depending on the nature of an individual’s post-nasal drip and its cause there are a number of paths to take when considering treatment. Antibiotics may be prescribed if the PND is a result of a bacterial infection.[1] Antihistamines are a recommended treatment for post-nasal drip resulting from allergies. First generation antihistamines can have side effects including drowsiness however.[11] Nasal steroid, such as Fluticasone propionate, may also provide relief.[12] Decongestants such as Sudafed cause a reduction in membranes through the tightening of blood vessels which resultantly limit PND.[13]

Ensuring individuals stay hydrated and as such consequently avoid alcoholic and caffeinated products which worsen symptoms is key but also cigarette smoke prone environments which can cause increased discomfort if inhaled. By drinking more fluids especially those which aim to thin mucous such as hot liquids can be effective in providing an individual with increased comfort in dealing with symptoms. Nasal irrigations such as saline based nose sprays can be purchased and used in order to help cleaning secretions within the throat which may be causing discomfort to the individual. Furthermore individuals can ask their doctors to prescribe steroid based nasal sprays which are safe and more effective than decongestant sprays that can be bought across the counter which may only remain helpful for a limited period of time [1][13]

References

  1. 1 2 3 Australia, Healthdirect (2018-04-06). "Post-nasal drip". Retrieved 2018-09-21.
  2. ↑ "Postnasal Drip: Causes, Treatments, Symptoms, and More". WebMD. Retrieved 2018-04-02.
  3. 1 2 Morice, AH (2004). "Post-nasal drip syndrome--a symptom to be sniffed at?". Pulmonary Pharmacology & Therapeutics. 17 (6): 343–5. doi:10.1016/j.pupt.2004.09.005. PMID 15564073.
  4. ↑ Publishing, Harvard Health. "No coughing matter - Harvard Health". Harvard Health. Retrieved 2018-09-21.
  5. ↑ Rosenberg, M (1996). "Clinical assessment of bad breath: current concepts". Journal of the American Dental Association. 127 (4): 475–82. doi:10.14219/jada.archive.1996.0239. PMID 8655868.
  6. 1 2 Bishop, Shawn (2012-06-01). "Postnasal Drip Not Usually Related to Bad Breath". Mayo Clinic - News network. Retrieved 2018-09-21.
  7. ↑ Ibrahim, Wanis H.; Gheriani, Heitham A.; Almohamed, Ahmed A.; Raza, Tasleem (2007-03-01). "Paradoxical vocal cord motion disorder: past, present and future". Postgraduate Medical Journal. 83 (977): 164–172. doi:10.1136/pgmj.2006.052522. ISSN 1469-0756. PMC 2599980. PMID 17344570.
  8. ↑ Gimenez; Zafra (2011). "Vocal cord dysfunction: an update". Annals of Allergy, Asthma & Immunology. 106 (4): 267–274. doi:10.1016/j.anai.2010.09.004. PMID 21457874.
  9. ↑ Pratter, Melvin R. (2006). "Chronic Upper Airway Cough Syndrome Secondary to Rhinosinus Diseases (Previously Referred to as Postnasal Drip Syndrome )". Chest. 129 (1): 63S–71S. doi:10.1378/chest.129.1_suppl.63s. ISSN 0012-3692. PMID 16428694.
  10. ↑ Sylvester, Deborah C.; Karkos, Petros D.; Vaughan, Casey; Johnston, James; Dwivedi, Raghav C.; Atkinson, Helen; Kortequee, Shah (2012). "Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist". International Journal of Otolaryngology. 2012: 1–5. doi:10.1155/2012/564852. ISSN 1687-9201. PMC 3332192. PMID 22577385.
  11. ↑ "Postnasal Drip: Causes, Treatments, Symptoms, and More". WebMD. Retrieved 2018-04-02.
  12. ↑ "Can Nasal Steroids Ease Allergy Symptoms?". WebMD. Retrieved 2018-04-02.
  13. 1 2 Publishing, Harvard Health. "That nagging cough - Harvard Health". Harvard Health. Retrieved 2018-09-21.
Classification
External resources
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.