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

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