What Is a Post-Nasal Drip?
Post-nasal discharge, also called post-nasal drip (PND), describes the sensation of mucous accumulation in the throat or a feeling that mucous is dripping downward from the back of the nose. PND can be caused by excessive or thick secretions or throat muscle and swallowing disorders.
Normally, the glands lining the nose and sinuses produce one to two quarts of thin mucus a day.
On the surface of this mucous membrane lining, the rhythmic beat of invisible cilia (which look like tiny hairs under a microscope) thrust the mucous backward.
Then it is swallowed unconsciously. This mucous lubricates and cleanses the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection.
Mucous production and clearance is regulated by a complex interaction of nerves, blood vessels, glands, muscles, hormones, and cilia.
Abnormal Secretions
Increased thin, clear secretions can be due to colds and flu (upper respiratory viruses), allergies, cold temperatures, bright lights, certain foods and spices, pregnancy and hormonal changes, various drugs (including birth control pills and especially high blood pressure medications), and structural abnormalities such as a deviated or irregular nasal septum.
(The septum is the cartilage and bony partition that divides the nose into its two sides, beginning at the nostrils and extending to the back of the nasal cavity.)
Vasomotor rhinitis describes a nonallergic "hyper-irritable nose," which may feel congested, blocked, or wet.
Increased thick secretions are frequently caused by wintertime low humidity in homes and buildings heated without adding moisture to the air. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products.
If the secretions of a common cold become thick and green or yellow, it is likely that a bacterial sinus infection is developing. Also, particularly in children, they can signify a foreign body in the nose (such as a bean, wadded paper, a piece of toy, etc.)
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Decreased secretions may be caused by any of the following:
- Long-term exposure to environmental irritants (such as cigarette smoke, industrial pollutants, and automobile fumes), which can dry and damage nasal mucous membranes. When secretions are reduced, they are usually thicker than normal and produce the false sensation of increased mucus.
- Structural abnormalities (such as nasal septal deviations), which alter air currents, may then dry surrounding membranes. (Thus, depending on their type, structural problems can increase or decrease secretions.)
- Age—Mucous membranes commonly shrink and dry with age, causing reduced mucus that is thicker than normal, which the elderly perceive as PND.
- Other less common disorders of the tissues lining the nose and sinuses can alter mucous production or flow.
Swallowing Problems
Swallowing is a complicated process by which food and fluid move from the mouth into the food pipe. It requires coordinated nerve and muscle interaction in the mouth, throat, and food pipe.
Swallowing problems may result in the accumulation of solids or liquids in the throat, which 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 accumulate. Coughing and vigorous throat clearing are often needed upon awakening.
- At any age, nervous tension or stress can trigger throat muscle spasms, resulting in a sensation of a lump in the throat.
- Frequent throat clearing, which usually produces little or no mucous, can make the problem worse by increasing irritation
- Growths or swelling in the food passages may slow or prevent the passage of liquids and/or solids.
- Swallowing dysfunction may be caused by gastroesophageal reflux, which is a return of stomach contents and acid into the esophagus (food pipe) or into the throat.
Heartburn, indigestion, and sore throat are common symptoms that may be aggravated while lying down (especially following eating).
Hiatal hernia, a pouch-like structure at the junction of the food pipe and stomach, often contributes to reflux.
Chronic Sore Throat
Postnasal drip often leads to a sore, irritated throat. Usually throat cultures will not show streptococcus or other infections, but the tonsils and other glandular tissues in the throat may swell, causing discomfort or a feeling of a lump in the throat. Successful treatment of postnasal drip will usually clear up these throat symptoms.
Before treatment is started, a diagnosis must be made. This requires a detailed ear, nose, and throat examination and possible endoscopic laboratory and X-ray studies
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