Causes of Postnasal Drip and How to Treat It

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November 26, 2018 | Family Medicine

Have you been experiencing upper respiratory symptoms such as sore throat, persistent cough, clogging in the tubes of the ear or sinus infections? If so, postnasal drip may be the cause.

Postnasal drip is not the same thing as a runny nose, but they share the same root cause: production of excess or abnormally thick mucus from glands within the lining of your nasal passages.

Complications of excess mucus

Mucus is a thick, sticky liquid produced by your nose to protect the body from infection. It traps viruses and bacteria and keeps your nasal passages moist. When your body is functioning normally, mucus mixes with saliva and is harmlessly swallowed. However, under certain circumstances, your body may produce more mucus than normal. When this happens, the excess mucus needs someplace to go. Postnasal drip occurs when the excess mucus exits from the back of your nose into the throat. A runny nose is excess mucus exiting from the nostrils.

Excess mucus in your nose can clog your sinus passages, which may lead to a sinus infection. Postnasal drip can also cause ear or throat discomfort. Your nose is connected to your ears and throat via an open structure called the pharynx, a cone-shaped passageway in the back of the head. Therefore, excess mucus that exits from the back of your nose can flow into your ears and throat from the pharynx. Excess fluid in your ear can cause an ear infection by clogging up the Eustachian tube. An unusual influx of mucus can also irritate your throat, causing soreness or coughing.

What causes excess mucus and postnasal drip?

Postnasal drip may be temporary or chronic, depending on its cause. Potential causes of temporary postnasal drip include the following:

• Viral upper respiratory infections, such as cold or flu
• Dry air or cold temperatures, often experienced during changes of seasons
• Irritating fumes from smoke, chemicals, cleaning products, perfumes or colognes
• Spicy food
• Pregnancy

In these cases, postnasal drip typically subsides after the condition runs its course or the irritating stimulant is removed.

Chronic postnasal drip is excess mucus production that persists for a long period of time and may be caused by the following:

• Side effects of certain medications
• Allergies
• Deviated septum, a congenital malformation of the nose

Treatments for postnasal drip

You can take steps to relieve the symptoms of postnasal drip. Exposure to steam, by taking a shower or drinking hot soup, for example, can help to thin the mucus and open the nasal passages. You can also prevent mucus from collecting in your throat while you sleep by lying on propped-up pillows. If your postnasal drip is caused by allergens or other irritants, nasal irrigation (e.g., using a neti pot) can help clear these foreign bodies away.

Postnasal drip can also be treated with medication, but the specific drug you should use depends on what is causing your symptoms. Steroid sprays or certain antihistamines, for example, are common treatments for postnasal drip caused by allergies. If your postnasal drip is caused by a bacterial infection, your doctor will likely treat it with antibiotics. Decongestants (such as pseudoephedrine) and expectorants (a medication to thin the mucus, such as guaifenesin) may also be effective.

If you have persistent upper respiratory symptoms, schedule an appointment with your primary care provider. He or she can help determine the cause and formulate an appropriate treatment plan.

Revere Health Orem Family Medicine is devoted to comprehensive healthcare for patients of all ages and providing thorough and timely healthcare for the entire family throughout all stages of life.

Sources:

“Treatments for Post-Nasal Drip.” Robert H. Shmerling, MD, Harvard Health.

https://www.health.harvard.edu/staying-healthy/treatments-for-post-nasal-drip

“What Is Postnasal Drip?” WebMD.

https://www.webmd.com/allergies/postnasal-drip#1

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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.

Causes, Symptoms and FDA Advice

What is Eustachian tube dysfunction?

The Eustachian tube is a small passageway that connects your throat to your middle ear. When you sneeze, swallow, or yawn, your Eustachian tubes open. This keeps air pressure and fluid from building up inside your ear. But sometimes a Eustachian tube might get plugged. This is called Eustachian tube dysfunction. When this happens, sounds may be muffled, and your ear may feel full. You may also have ear pain.

Symptoms

If you have Eustachian tube dysfunction:

• Your ears may feel plugged or full.
• Sounds may seem muffled.
• You may feel a popping or clicking sensation (children may say their ear “tickles”).
• You may have pain in one or both ears.
• You may hear ringing in your ears (called tinnitus).
• You may sometimes have trouble keeping your balance.

Your symptoms may get worse with changes in altitude. This includes flying in an airplane, riding in elevators, driving through mountains, or diving.

What causes Eustachian tube dysfunction?

The most common cause of Eustachian tube dysfunction is when the tube become swollen (inflamed) and mucus or fluid builds up. This can be caused by a cold, the flu, a sinus infection, or allergies. Some people are at greater risk for Eustachian tube dysfunction. They include:

• Children. Their tubes are shorter and straighter than those of an adult. This makes it easier for germs to reach the middle ear and for fluid to become trapped there. Also, children’s immune systems are not fully developed. This makes it harder for them to fight off infections.
• People who smoke. Smoking damages the cilia (the tiny hairs that sweep mucus from the middle ear to the back of the nose). This can allow mucus to gather in the tubes.
• People who are obese. Fatty deposits around the tubes can lead to Eustachian tube dysfunction.

How is Eustachian tube dysfunction diagnosed?

Your doctor will talk to you about your symptoms and examine you. They will examine your ear canals and eardrums, your nasal passages, and the back of your throat.

Can Eustachian tube dysfunction be prevented or avoided?

Reduce your risk of developing this condition by treating the underlying cause of the blockage. This is usually allergies, a cold, or the flu.

Treatment

Symptoms of Eustachian tube dysfunction usually go away without treatment. You can do exercises to open up the tubes. This includes swallowing, yawning, or chewing gum. You can help relieve the “full ear” feeling by taking a deep breath, pinching your nostrils closed, and “blowing” with your mouth shut.

If you think your baby may have Eustachian tube dysfunction, feed him or her. You can also give them a pacifier. These encourage the swallow reflex.

If these strategies don’t help, your doctor may suggest other options. These can include:

• Using a decongestant to reduce the swelling of the lining of the tubes
• Taking an antihistamine or using a steroid nasal spray to reduce any allergic response
• Making a tiny incision in the eardrum and suctioning out the fluid in the middle ear. This gives the Eustachian tube lining time to shrink while the eardrum is healing (usually 1 to 3 days).
• Implanting small tubes in the eardrums. These let built-up fluid drain out of the middle ear. Children who get a lot of ear infections sometimes get tubes in their ears. They stay in up to 18 months and fall out on their own.
• Using a balloon dilation system. A doctor will use a catheter (long, flexible tube) to insert a small balloon through your nose and into the Eustachian tube. When it is inflated, the balloon opens a pathway for mucus and air to flow through the tube. This can help it function properly.

FDA warning

The U.S. Food and Drug Administration (FDA) advises against the use of ear candles (inserting a special candle in the ear). It is supposed to pull wax and debris out of your ear as it burns. Ear candles can cause serious injuries and there is no evidence to support their effectiveness.

Living with Eustachian tube dysfunction

Managing your symptoms when you have allergies or a cold is important. This can keep your Eustachian tubes clear and prevent an infection. Home care usually takes care of any problems. This includes exercises such as swallowing or yawning. If you or your child show symptoms of severe pain in the ear, call your family doctor.

Questions to ask your doctor

• My ears feel full and don’t feel better when I yawn. Could I have Eustachian tube dysfunction?
• What can I do to make my child more comfortable?
• My child has Eustachian tube dysfunction. Does this mean they will have ear infections?
• Is there anything I can do when I travel to make myself more comfortable?
• Could my allergies make Eustachian tube dysfunction worse?
• What is the best way to treat my symptoms?

Resources

National Institutes of Health, MedlinePlus: Otitis media with effusion

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Discharge from the ear, or otorrhea

Allergy

Fungus

Otitis

Sulfur plug

Mastoiditis

Tympanic membrane rupture

Otomycosis

17713

June 24

Discharge from the ear: the causes of occurrence, in which diseases occur, diagnosis and methods of treatment.

Definition

Earwax is a physiological secretion from the ear canal and protects the hearing aid from pathogenic bacteria. It consists of fat, fatty acids and fat-like substances, as well as various mineral salts. Normally, a person produces 15–20 mg of earwax during the month, which looks like a sticky yellow-brown mass. All other discharges are considered pathological and indicate ear diseases.

Types of discharge from the ear

The discharge may be transparent, white, light or dark yellow, greenish (in the presence of pus). If blood enters the ear secretion, the discharge becomes reddish or brownish in color.

The discharge may be watery in consistency, have a cheesy or flaky texture, and may sometimes form crusts.

An unpleasant smell of discharge due to the presence of pus in them can serve as a diagnostic sign.

What diseases and conditions cause discharge from the ear

Sulfur plugs . Excessive work of the sulfur glands leads to the formation of a sulfur plug. Most often, this problem occurs in patients with diabetes mellitus, metabolic syndrome, high cholesterol levels in the blood. The formation of sulfur plugs provokes an increased viscosity of sulfur, dry skin, small foreign particles (for example, industrial dust) entering the ear, as well as excessive hair growth in the ear canal. Often, sulfur plugs are observed in people involved in water sports, using hearing aids, miniature headphones.

With improper hygiene measures and independent attempts to remove excess earwax, there is a risk of pushing it deeper into the ear canal, thereby causing a plug to form.

Clinical signs of sulfur plug are pain and stuffiness of the ear, tinnitus, especially painful when sulfur comes into contact with the eardrum, sometimes headache, dizziness, nausea.

Mucopurulent and purulent discharge is a symptom of inflammation of the outer and middle ear. In inflammation external ear (otitis externa) pathological process can develop in the auricle and external auditory canal (up to the tympanic membrane). Most often, external otitis occurs against the background of infection of the ear with bacteria and microscopic fungi. Its first signs are, as a rule, pain in the ear, itching, less often – hearing loss and a feeling of fullness. Mucopurulent discharge appears only with a common form of the inflammatory process throughout the auditory canal.

The source of purulent discharge in the outer ear can also be a boil located in the shell or ear canal. With otitis media mucopurulent and purulent discharge results from infection of sterile effusion from inflamed ear tissues. Since the chamber of the middle ear is closed by the tympanic membrane, purulent discharge may appear in the outer ear only after the formation of a hole in it. This is preceded by severe pain in the ear, fever, hearing loss, and in children – overexcitation, sometimes vomiting.

When mastoiditis (inflammatory lesion of the mastoid process of the temporal bone), purulent discharge from the ear also appears. As a rule, this disease develops as a complication of otitis media and is accompanied by fever, soreness and swelling in the mastoid process behind the ear.

Clear bloody or purulent discharge occurs in acute infectious myringitis (inflammation of the eardrum), which may be of fungal or bacterial origin. Bubbles filled with blood form on the surface of the eardrum, which then burst. In addition to discharge, ear congestion is observed.

Transparent, colorless or slightly pinkish discharge from the ear may be the result of liquorrhea – the outflow of cerebrospinal fluid. It enters the auricle in case of skull fractures (usually temporal) due to trauma.

In addition, transparent watery discharge sometimes accompanies allergic otitis media , which is also characterized by other signs – itching, ear congestion.

Unaltered blood appears from the ear, usually after injury and rupture of the eardrum .

Such an injury can be caused by acoustic and mechanical shocks, as well as due to improper hygiene procedures. A ruptured eardrum is always accompanied by severe pain.

The appearance of bloody-purulent discharge from the ear is one of the evidences of the presence of a polyp on the tympanic membrane or mucous membrane of the middle ear . A polyp is an overgrowth of tissue in response to its irritation. The appearance of a polyp is preceded by active inflammation of the middle ear. In addition, polyps can be the result of myringitis, otitis externa, malignant neoplasms. Perforating the tympanic membrane, the polyp can protrude into the area of ​​​​the external auditory canal, leading to hearing loss.

Insignificant secretions, sometimes forming crusts and having an unpleasant odor, are characteristic of cholesteatoma – a tumor-like formation formed from the epidermis of the ear canal. In most cases, cholesteatoma complicates chronic purulent epitympanitis and is formed from layers of keratinized epidermis, water, proteins, fats and cholesterol. The formation of cholesteatoma is accompanied by feelings of heaviness and fullness in the ear, headache. If left untreated, it can gradually invade the mastoid process and the cranial cavity.

At otomycosis loose curdled discharge is observed. The main culprits of the disease are molds (often localized in the outer ear) and yeast-like fungi (more often inhabiting the middle ear). Clinical signs of otitis externa in these cases include pain and colored cheesy-necrotic discharge from the ear. Patients complain of tinnitus and dizziness.

Discharge that contains large, fatty flakes, sometimes mixed with pus, is characteristic of seborrheic ear dermatitis . The disease can affect not only the ear, but also the scalp. Clinical signs are severe itching, swelling of the auricle, peeling of the skin and weeping wounds.

Clear discharge mixed with blood (sanitary discharge) indicates bullous or influenza-like otitis media . Bullae (vesicles with fluid) occur on the surface of the ear canal and eardrum. When they burst, the liquid with the ichor flows out through the ear canal into the auricle.

Which doctor to contact for ear discharge

In most cases, ear diseases are characterized by a clear clinical picture, which is based on pain. These patients are treated by an otorhinolaryngologist.

In the presence of a traumatic brain injury, which is accompanied by liquorrhea, urgent hospitalization is necessary. Otherwise, a poor prognosis is possible.

Discharge from the ear is not always accompanied by pain, in particular with allergic otitis, which is treated by
therapist,
pediatrician and
allergist-immunologist.

Diagnosis and examination of discharge from the ear

If wax plug is suspected, the doctor performs an otoscopy, during which an accumulation of wax in the ear canal is detected. Diagnosis of otitis externa and otitis media is carried out on the basis of patient complaints, otoscopy, palpation of the parotid region. It is recommended to sow discharge from the ear to determine the causative agent of the disease and its sensitivity to antibiotics. Perhaps an audiometric study.

Traumatic brain injury, which is accompanied by liquorrhea, is diagnosed using radiography and CT.

X-ray of the skull

X-ray examination of the skull to detect violations of the structure and integrity of the bones of the skull of various nature.

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CT scan of the brain and skull

Scanning of the brain, skull and surrounding tissues, which allows diagnosing various pathologies.

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To diagnose cholesteatoma and mastoiditis, the doctor performs otoscopy and radiography.

X-ray of the mastoid processes

X-ray examination of the mastoid process of the temporal bone to assess its integrity and identify other pathology.

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If otomycosis is suspected, endomicroscopic (examination of the ear under an operating microscope) and microbiological examination of ear discharge using microscopy and culture are recommended. Diagnosis of bullous otitis media includes sowing fluid from the ear, audio and tympanometry, and radiation examination methods. It is also possible to use serological methods of blood analysis.

What to do if there is discharge from the ear

If clear discharge from the ear appeared after an injury, urgent hospitalization is necessary.

If there is an increased excretion of sulfur, you should seek the help of an ENT doctor who will recommend proper care and personal hygiene methods acceptable at home.

It is strongly not recommended to clean the ear canal with the help of items not intended for this purpose.

Treatment for ear discharge

If a sulfur plug is detected, the doctor removes it, after softening it with special preparations. Remove plugs by lavage or aspiration and curettage.

Irrigation is possible only in the absence of contraindications, which the doctor will definitely inform about (perforation of the tympanic membrane, otitis externa).

Treatment for otitis media may include pain relief, physiotherapy, and etiotropic therapy, depending on the causative agent of the disease. The allergic nature of ear discharge requires the use of antihistamines. Cholesteatoma is treated only with surgery.

Sources:

1. Clinical recommendations “Acute otitis media”. Developed by: National Medical Association of Otorhinolaryngologists. – 2021.
2. Morozova S.V. Ear wax: topical issues of norm and pathology in clinical practice. breast cancer. No. 3 (II), 2018, pp. 53–57.
3. Clinical guidelines “Chronic otitis media”. Developed by: National Medical Association of Otorhinolaryngologists. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Ear discharge

To the guide

Discharge from the ear often indicates the development of an inflammatory process in the outer or middle ear.

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Ear wax protects against the penetration of pathogens and foreign bodies into the ear canal. Therefore, its formation is physiologically determined and is considered the norm. Other discharge from the ear usually indicates pathology and may contain purulent masses and blood impurities.

Types of discharge

According to their type of discharge are divided into several types:

Purulent discharge

The leakage of pus from the ear canal occurs with inflammation of the outer and middle ear, and is also characteristic of external and acute otitis media with perforation of the eardrum, respectively. Other causes of purulent discharge can be otomycosis, in which fungal microflora parasitizes in the ear, and furunculosis.

This is the name of inflammation of the sebaceous glands in the ear canal, accompanied by the formation of a limited cavity (one or more) filled with purulent secretion. The clinical picture may be supplemented by other signs: the development of hearing loss, congestion and pain in the ear on the side of the lesion, a sensation of tinnitus, which is often mixed with dizziness. The physical condition of the patient is aggravated by a runny nose, fever, an increase in local lymph nodes, and pain in the ear region.

Spotting

Discharge from the ear with blood impurities also occurs with the development of an inflammatory process in the middle and outer sections. But the most common cause of such phenomena is trauma to the eardrum or other internal structures, as a result of exposure to mechanical objects that have fallen into the ear canal, or pressure drop. In the latter case, the cause may be barotrauma, which is often found in novice scuba divers with improper diving to depth due to a sharp change in the difference between external and internal fluid pressure.

Transparent highlights

There are also clear discharges from the ear. A striking example is exudative otitis media, during the development of which fluid accumulates in the middle ear cavity. Rupture of the tympanic membrane leads to the manifestation of the contents. Inflammation for this form of otitis is uncharacteristic.

Cerebrospinal fluid, which is also clear, may leak from the ear. A similar picture can be observed with craniocerebral injuries that led to a fracture of the base of the skull.

Diagnostics

Elucidation of the etiology of this phenomenon is carried out on the basis of the patient’s own complaints and instrumental examination data.

As part of the diagnosis, otoscopy is used, the main task of which is to exclude pathology in the ear. The doctor also performs the toilet of the ear, clearing the ear canal from the contents, using micro-instruments. For a more detailed examination, otomicroscopy is used.

If an inflammatory process is confirmed, discharge from the ear is subject to microbiological examination, which makes it possible to establish the type of pathogen and identify its sensitivity to antibiotics. Head injuries are the reason for performing a computed tomography.

Treatment

Treatment according to the cause of the event:

• Drug therapy – antibacterial drugs in the form of drops;
• Opening of a furuncle with furunculosis.