Your postnasal dripping may not be a drip or even related to your nose

Many patients complain of postnasal dripping. Most people perceive this as a sensation of mucus buildup in the back of the throat. The majority of the patients point to the different parts of the neck and the throat area as the center of their discomfort. Various patients also feel sensation of a ball being stuck in the back of the throat or feeling of discomfort with swallowing or symptoms with speaking or breathing.
A significant number of patients with self-described symptoms of postnasal dripping actually deny any specific nasal or sinus symptoms such as congestion, runny nose, difficulty breathing, allergies, or recurrent sinus infections.

The area in the back of their throats, the same area that most people refer to as a center of the postnasal dripping, can be the receiving end of secretions from various organ systems. The obvious organ system could be the nose and sinuses. In patients with an upper respiratory infection, allergies, cold, or sinusitis, the secretions can then drip down in the back of the nose and land in the throat. This can create very sticky secretions which the patients feel a great deal of discomfort trying to alleviate. By addressing the nasal symptoms directly, the dripping could be reduced, and the sensation of postnasal dripping can be significantly improved. Many patients use nasal saline irrigation as well as various prescription nasal preparations and antibiotics that are appropriate in each individual case. Most patients with dripping in the back of the nose that is actually from nose and sinuses do have significant amount of nasal symptoms that are obvious. It is rare to have true postnasal dripping with no obvious nasal and sinus symptoms.

Other organ systems can also affect the back of the throat. One of them could be the lungs and trachea. In patients suffering from chronic asthma, chronic bronchitis, pneumonia, or various lung symptoms, the secretions can come up and land on the back of the throat. These patients typically complain of incessant cough, difficulty breathing, asthma-like symptoms, and chronic secretions. These secretions also tend to be more productive, and they can present as yellow or green secretions. Many patients with either asthma or pneumonia-type symptoms are also significantly symptomatic in addition to the sensation of postnasal dripping.

A third organ system that can give a sensation of postnasal dripping is actually the stomach.
Our stomachs make a quite bit of acid on a daily basis to digest our food. We have various protective mechanisms to keep the acid down in the stomach and prevent from regurgitating back through our esophagus into the back of our throats. However, in certain patients with acid reflux this can result in a sensation of something not being quite right in the back of the throat. Some patients complain of a feeling of globus (as though a ball is stuck in the back of the throat). Other patients describe raspiness of the voice, difficulty breathing, waking up several times in the middle of the night with cough, and a feeling of not being able to alleviate something sticky in the back of the throat. The kind of reflux that gives many people a sensation of postnasal dripping could actually be what is called silent reflux. This has to do with the protective mechanisms and how much they can protect us before we actually develop symptoms in our stomach area. It is thought that our protective mechanisms allow enough relief for us to have up to 50 episodes of reflux per day before we feel anything. If the patient experiences more episodes of reflux than that, we start having symptoms of heartburn. However, certain patients in whom the acid reaches the back of the throat where there are no protective mechanisms feel a discomfort much sooner. The treatment for these patients usually centers on diet modifications to comply with reflux guidelines, antacid medications, and gargling on a regular basis with salt and water.

Patients with postnasal dripping would be best served by seeing their specialist to examine all options. Once the exact sources of the symptoms are found, the appropriate treatment protocol can be prescribed.

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Posted in: Throat


Responses:

  1. My cough is of a totally different description than mentioned; I feel as if the epighlottis is not protecting the entrance to my trachea, thus allowing saliva, post nasal drip,fluid, food (chewed and unchewed) water- any thing else in my throat- to enter into my lungs. My fear is developing pneumonia, as I did last year, I feel, from these same symptoms,(inability to breathe in or out, coughing to relieve symptoms of a feeling of phlegm running down Into that one spot In my throat, gagging on excess mucosy saliva, choking to breathe as I’m eating or speaking. as I mentioned above.

    Comment by Rosa James on November 26, 2017 at 6:46 pm

  2. It seems that you have done a good amount of investigating and treatment for this condition. You seem very knowledgable. Rather than giving you guesses, you are best served by being examined and also review any test or imaging results before making any more changes. If you happen to be in NYC, I would love to look into this with you.

    Comment by DrNamdar on January 30, 2018 at 11:10 pm

  3. And when considering the stomach, consider Candida. It caused my decade of throat clearing and miserable morning hacking and choking. I went on a candida diet and took oil of oregano for a month and now phlegm free. I look at candy, cookies and alcoholic drinks differently now.

    Best
    dc

    Comment by dcampeau on December 17, 2017 at 3:08 am

  4. Hey Dcampeau,

    I have gone through a slough of testing for my post nasal drip, fatigue and muscle pain and it seems none of these three main reasons aforementioned above in the article are causing my post nasal drip/ drainage, after looking at photos from various sufferers of Candida infections I have come to the conclusion that I may be suffering from a fungal infection. Would it be ok if I emailed you with more questions?

    Regards,

    Kevin

    Comment by Kskirkpatrick on March 10, 2018 at 1:41 am

  5. Thank you for your interest. At the present time my office is not set up to carry out tele-medical consultations.

    Comment by DrNamdar on April 4, 2018 at 1:42 pm

  6. Hello,

    I am an 18yo male. I have been suffering from a sore bumpy throat for months now. I believe i have narrowed the cause down to irritation caused by post nasal drip. However, my nose seems to be completely normal most of the time. I am swallowing mucus most of the day. I am confident it is mucus and that it is coming from my nose. How can this be if i have no nasal symptoms? On top of that, what should i do to alleviate my symptoms? Your time and responses are appreciated.

    Comment by Nick on April 9, 2018 at 3:06 am

  7. Not all post nasal dripping is from the nose, as the article suggests. You are correct to doubt the nose if there are not enough nose and sinus symptoms. Your best bet is to have a thorough exam to identify the source.

    Comment by DrNamdar on April 27, 2018 at 5:29 pm

  8. Do you know of any doctors in the Phoenix area who are knowledgeable in your field. I think I’m going to die.

    Im taking omeprazole for GERD, allergy medicine, sinus medicine, etc. I need to figure this out because I can’t live like this, coughing and struggling for oxygen. It does feel like post nasal drip is somehow sneaking into my lungs. When I breathe I wheeze and gurgle. Ive had this going on 4 years. Last year I had a 4 month bout of laryngitis because of this.

    I desperately want to enjoy life. I baffle all doctors I’ve seen, from Pulminologists to allergists to an ENT specialist. Ive had to go to emergency room because I was suffocating in my own juices.

    Please recommend someone in Phoenix. As I said, I baffle all doctors I see, and being treated for a variety of ailments all causing these horrible symptoms. Thank you so much for your advice.

    Comment by Mary Brancato on April 21, 2018 at 1:31 am

  9. I am so sorry, but I have no network of doctor in your area I know personally and would recommend.

    Comment by DrNamdar on April 27, 2018 at 5:27 pm

  10. I ve been suffering for 2 years and nothing helped.The only symptom that I have is post nasal drip…nothing more…..no runny nose,no cough,no pain,no allergy symptoms.Recently,I had a surgery on 28th March (septoplasty and turbinate reduction).1month and 2 weeks and here I am searching for a cure for my post nasal drip.Im so desperate cause I really thought Im gonna get rid of it if I do the surgery.A few months ago I ve done an allergy test and also the doctor looked in my stomach.With all being said,I figured out that I dont have any silent acid reflux and allergies so Im asking you,if I dont have allergies,acid reflux,sinus infection,no symptoms what could cause this post nasal drip thats destroying my life?

    Comment by AlexI on May 10, 2018 at 12:31 pm

  11. I have sympathy for everything you have gone through. As you see yourself, what we label as “post nasal drip” could be very challenging to both the patients and the doctors trying to solve the problem. These secretions could be from the nose, the stomach, or the lungs. Alternatively, some people do have an issue with the texture of their mucus and have more difficulty handling the secretions. Hydration and use of Mucinex could also come in handy.

    Comment by DrNamdar on June 11, 2018 at 3:11 pm

  12. I have a hard time swallowing food and they said I have cobble stones in the back of my throat with post nasal drip and a little bit of gerd my neck feel tightness at all times and I have a bit of anxiety it’s very discomforting. I also feel like my nose is stuffy and can’t. Breathe from my nostrils I also have a little bit of asthma. Do you know of any good doctors in Washington state?

    Comment by Bee victoria on May 18, 2018 at 4:30 am

  13. I’m sorry, I don’t have any network of colleagues in your area I am familiar with. However, University of Washington is surely a good resource.

    Comment by DrNamdar on June 11, 2018 at 2:57 pm

  14. I am a 33 year old male that just underwent and endoscopy. I was diagnosed with Gerds. I am on 60 mg of pantaprozole and 40 mg of pepcid. I feel like I have drainage in the back of my throat and sometimes feels there is a lump in the back of my throat. Do you think that this is caused by my Gerds, or that I might have Silent Reflux. I feel that going to a Gastroenterology has not alleviated my problems. Would an ENT be able to diagnose me better and can they do so without sticking a catheter up my nose> ( I have a fear of chocking and really want to avoid that procedure.

    Thank you

    Comment by Adam C Trimble on June 18, 2018 at 4:20 pm

  15. Any time you have a funny feeling in the back of the throat, the area should be examined directly with a flexible laryngoscope to assure there are no masses. Often GERD or LPR can be diagnosed or confirmed at the time of endoscopy.

    Comment by DrNamdar on June 20, 2018 at 4:35 pm

  16. Dr. ~ I’m a 73-year-old male. Well over ten years ago I was seen by an ENT specialist for what I described as a mass feeling in the back of my throat near by adams apple. I would feel this sensation only when I swallowed. The specialist found no problems at the time other than acid reflux and put me on Nexium. It became less pronounced, but never totally went away. I just got used to it and learned to live with it. Fast forward to the present where I find myself being bothered by it again much more pronounced and complicated by constant post nasal drip that I find myself constantly snorting to try to clear it from my sinus area. I can feel the build up around the top of my throat and my ears and nose. It doesn’t affect my breathing, drinking, eating, sleeping or any other part of my waking life. There is no pain, hoarseness or voice complications. I should add that sometimes I’m much more aware of it than others, but none the less, it’s an annoyance that’s driving my bonkers. I was going to put off attention to it until I have my annual physical in a couple of months, but do you think I should attend to it sooner?

    Comment by Jack on July 1, 2018 at 10:48 pm

  17. Reflux can have a cyclical patter: Occasially it bothers you more, and occasionally it improves either because of you did as an intervention or just pure luck. However, you can’t always assume that the same exact problem from 10 years ago is what is happening now. Your best bet is to have the area examined and get the right treatment.

    Comment by DrNamdar on July 23, 2018 at 3:53 pm

  18. Dear Dr. Namdar

    I am 35 year old male.I have a case where my nasal mucous membrane seems oversensitive. I have a post nasal drip whenever I speak fast, laugh or eat. something stimulating. There was a time when I eat spicy foods 2 years ago in consecutive days and my nose was really sensitive and my tongue felt burned. and having post nasal drips all day long. At the present I don’t feel fully healed since it is not hundred percent back to normal.

    I have tried Triprolidine, Pseudoephedrine and methylprednisolone with no effect. I have done nasal endoscopy for many times but still the doctors could not figure it out what is the problem.

    What is the name of this case ? Is there anything you could recommend to me ?

    Best Regards,

    Kelvin

    Comment by Kelvin on August 6, 2018 at 10:51 am

  19. Not having had the chance to examine you, it seems you might possibly have vasomotor rhinitis. Kindly consult your local ENT to see if this diagnosis makes sense for what you have and if we can treat if for you.

    Comment by DrNamdar on October 11, 2018 at 2:36 pm

  20. I’m a 38 year old mom & I’ve suffered with constant post nasal drip for almost 20 years. 3 out of my 5 kids have it too. It’s aggravated by weather changes especially, and I seem most burdened by it. Sometimes when I am laying down, or turn my head sideways just right I feel like my throat is sticking together right by the lymph node under my chin. It doesn’t always happen, but when it does it makes my anxiety go through the roof. I can’t even lay down occasionally because it is so bad. I’ve been checked out for everything and they say nothing is out of the ordinary. Kind of at a loss and curious if you have thoughts on where I should go from here or a specific avenue I should speak with my doc about. (Already did the scan of my sinuses, saw the ent, & allergist). Thanks

    Comment by Heather on August 27, 2018 at 6:34 am

  21. Many people might suffer from post nasal drip that is not due to allergies or sinus issues we can see. It can even be from acid reflux disease, or from lung secretions. If nothing else is found, there are medications and minor procedures to slow down the mucus glands.

    Comment by DrNamdar on October 11, 2018 at 2:32 pm

  22. I get viral infection which leads to post nasal drip and bronchitis . My CT scan shows right sight septal deviation although i dont have any breathing .

    Does brochitis lead to post nasal drip or is it vice versa post nasal drip leads to bronchitis …
    I am more concerned about bronchitis

    Rakesh

    Comment by Rakesh on October 4, 2018 at 9:21 pm

  23. Many people believe that from the tip of our nose down to the very bottom of our lungs is all one organ. Any condition of the nose and sinuses can also affect the bronchus and lungs, and vice versa.

    Comment by DrNamdar on October 11, 2018 at 2:29 pm

  24. I have read this article and all responses, and i have realized there different causes of post nasal drip.
    So whatever the cause of PND, is there any medication to treat it permanent so that it does not reappear?
    Mary

    Comment by Mary Divine on November 6, 2019 at 10:33 am

  25. The whole point is that there could be so many different causes behind it. Often we don’t have one definitive test that can tell us exactly what the cause is in each person. Therefore we also don’t have any ONE treatment to make the feeling go away permanently.

    Comment by DrNamdar on April 28, 2020 at 2:20 pm

  26. Hello! I’m just a little concerned about my cough because I’ve been on to cough suppressanrs, anti histamie and antibiotic (as referred by our school doctor), but none worked. I currently do not have phlegm nor much of nasal clogging or runny nose, just a cough and a feeling that something is stuck in my throat. My last remembrance of the feeling of something stuck here was two weeks ago after eating instant noodles but the feeling is only very mild. Is it possible that I have aspirated food? And what can I do? What kind of doctor do I call? I do not have chest pains nor symptoms of choking.

    Comment by EJ SANTOS on February 3, 2020 at 6:28 am

  27. Sorry to hear your concerns have been dragging out. Aspirated food usually causes such severe symptoms that you would need to be seen in emergency room right away to have it removed. It doesn’t just sit there to give you a nagging cough. Best is to make an appointment with your local ENT specialist to have the area examined including performing an office endoscopy.

    Comment by DrNamdar on April 28, 2020 at 2:12 pm

  28. I have had awful post nasal drip, terrible hawking up nothing, but constant clearing of throat, wake up choking, tired from constant all day throat clearing. ,after a bad cold 8 years ago.. I feel no one has taken time to cure this . I have seen 6 ENT and no help. I have had a chest xray, allergy testing, endoscopy, colonoscopy, and a cat scan……..all came back showing nothing wrong,, so they gave me acid reflux meds. They did not help at all because acid reflux doesn’t bother me. My lungs are not the problem so I called the cat scan ENT and he reviewed the cat scan and said I have narrow sinus drainage tubules. I need asap surgery. Did the cold 8 years ago mess me up? Will an antibiotic help? Anything other than surgery? I feel no one has taken the time to help me get rid of this awful feeling. I feel like I have a disease with no cure. I have been taking serrapeptase for 3 weeks……I am praying this will help. Please offer any help you can to relieve me of this awful disruption of life

    Comment by Katrina Smith on April 18, 2020 at 11:07 pm

  29. Sorry to hear you’ve been suffering from this for such a long time. The most common causes of feeling of post nasal dripping could be from nasal sources (allergies, sinuses), lungs issues (bronchitis, asthma, pneumonia), or stomach issues (reflux). It seems you have already investigated all these sources. The other option to investigate is that some people feel an uncomfortable feeling in the back of throat from stress.

    Comment by DrNamdar on April 28, 2020 at 1:46 pm

  30. Hi, I have experienced post nasal drip in my life, but only when I’ve been sick and usually only as I’m starting to get better actually. It’s tormenting.

    I’ve been having some breathing issues for 3 months. Doctors are quick to just say “asthma” and send me home with a bag of steroids because I have a history of “asthma.” However, inhalers have never worked for me and I’ve had tests that show that my lungs work fine. So I’m not convinced I ever had asthma. Plus, it ONLY happens during exercise. But 3 months ago, overnight, I started having issues. A month into it, I went to the doctor. That’s when they put me on Symbicort. And then I switched to Alvesco. No relief from symptoms at all. Actually, they’ve only gotten worse. One of my symptoms is that I feel like I’m exhaling gas every time I breathe out. I have had symptoms every single day for 3 months and I know the day they started. Like just out of blue, they were there and haven’t gone away.

    SO my questions… could I have developed chronic post nasal drip over night (without any noticeable sinus related symptoms) but just not know it? Could the inhalers be causing post nasal drip? I’ve noticed since being on the Alvesco, I actually notice dripping in my throat. I didn’t before. I only wonder if this has been a hidden ongoing issue because of the way it feels when I exhale. Could an ENT help rule stuff out for me?

    Comment by Gwen on July 2, 2020 at 6:18 am

  31. An ENT could at least investigate the upper part of the respiratory tract to make sure there are no areas of stricture or lesions.

    Comment by DrNamdar on July 30, 2020 at 2:18 am

  32. I’m 14 years old and a male I think I’ve had post nasal drip for a while but more recently it’s kinda hard for me to swallow something without a drink and I’m concerned about it. What is it or what could it be?

    Comment by Aidan on July 9, 2020 at 12:41 am

  33. Thanks for sharing your concerns. It is really not possible to tell over the internet what is the particular situation that is giving you these symptoms. Please ask your parents to make an appointment with your local ENT to investigate.

    Comment by DrNamdar on July 30, 2020 at 2:17 am

  34. I have nasal drip for these past couple of months and I would clear my throat 24/7 I don’t have a cough nor any allergy reaction it don’t affect my breathing but I do have asthma it has gotten better after taking some medication. Some how I would still feel the nasal drip but it don’t be nothing there and it’s very uncomfortable I’m very concerned

    Comment by David on July 9, 2020 at 3:23 pm

  35. Hi,
    I’m a 48yo male with a deviated septum. I have travelled quite a lot and areas with more nature cause me a lot of post nasal drip, while deserts and areas by the sea are best for me. But I have no allergies besides mold (I had a full test do with many allergens). Whenever the weather changes my nose gets more stuffy and my throat feels like it has thick mucus and needs constant clearing, which is debilitating. However, if I engage into some exercise, it somehow totally clears up.
    Since we live in a mask era, I started to experiment wearing a ffp3 mask at home (like the n99) and I get much less congestion, so something in the air is making it happen.
    When I have episodes, I feel like I have a flu and an ENT even told me that my throat was irritated and I should stop smoking.. although I don’t smoke.
    One thing which is odd is that I had to do a few cycles of clindamycin and every time my nose congestion is almost gone.
    Is there a possibility that I have a bacteria fauna in my nose and throat causing all these symptoms? But then, why would the mask help?

    Comment by Thomas on July 11, 2020 at 12:54 pm

  36. Masks protect from external exposure, including mold and pollen etc. You might also want to invest in an air filter to do the same for the ambient air around you. Many antibiotics also have an anti-inflammatory effect, and maybe that’s why the clindamycin helps with the congestion.

    Comment by DrNamdar on July 30, 2020 at 2:16 am

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