OVERVIEW: Postnasal is a condition that causes mucous and secretions to drip from the back of the nose into the throat. A small amount of postnasal drip is normal and part of good nasal health. However, some patients may experience large amounts of mucous or constant drip that can vary from a daily annoyance to a debilitating condition with negative impact on quality of life. Patients with PND also often notice throat symptoms or nasal and sinus symptoms.

SYMPTOMS: Postnasal drip can cause or is associated with symptoms of nasal congestion and blockage, loud snorting from back of nose, mucous clearing from nose and throat, throat irritation, throat clearing, trouble sleeping, ear pressure and popping, bad taste in mouth, cough and increased asthma symptoms.

CAUSES: Inflammation of the lining of the nose and the tissues between the nose and upper throat results in increased mucous and secretions that then drip into the lower throat. Allergies, colds and sinus infections are common causes of this inflammation. A common and often overlooked cause of postnasal drip is Acid Reflux. When we lie down at night or are having active acid reflux, the stomach acid (and the enzyme Pepsin) can travel up to the back of the nose and sinuses causing chronic and recurrent inflammation resulting in symptomatic postnasal drip.

DIAGNOSIS: A through history and exam can help determine the cause of the Postnasal drip. Nasal Endoscopy done in the office allows direct visualization of the nasal passages and the postnasal tissues to determine which factors are causing the symptoms. If sinus disease is a possible cause of PND then a CT Sinuses can help determine that. An esophagram is a non-invasive study that can determine if acid reflux is present as the cause of postnasal drip. Other causes of chronic rhinitis (inflammation of the nasal passages) such as vasomotor, temperature changes, allergies, autoimmune disease and nasal polyps can also be identified with Nasal Endoscopy and CT scans.

TREATMENT: Once the cause or causes of the Postnasal drip are identified treatment is primarily medical by using various nasal sprays to decrease the inflammation and mucous in postnasal area. If any sinus disease is identified, it can be treated. For patients that have more bothersome postnasal drip or who have not responded fully to medical management a minimally invasive procedure can be done to control the congestion in the nose and decrease the postnasal drip. This procedure is called Posterior Nasal Nerve Ablations and can be done in the office or in the operating room (Rhinaer, Clarifix).

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