What can cause post nasal drip: Treatments for post-nasal drip – Harvard Health
Treatments for post-nasal drip – Harvard Health
You thought it would never end: that tickle in the back of your throat that made you cough or have to clear your throat. It’s been going on for months. And now you know why: post-nasal drip. It’s a common diagnosis. It can happen for a number of reasons: allergies, viral infections (including the common cold), sinus infections, irritants in the air (such as fumes or dust). Less common causes include something stuck inside the nose (common in small children), pregnancy, and certain medications. Temporary – and normal – causes of post-nasal drip includes certain weather conditions (especially cold, dry air) and spicy foods.
Whatever the cause, the problem is a steady trickle of mucus from the back of the sinuses that irritates the throat and nagging cough or other symptoms.
Now that you have an official diagnosis, what can you do for it? There are a number of treatment options, including home remedies and over-the-counter medications:
- A humidifier or steam inhalation (as during a hot shower)
- Keeping well-hydrated (to keep the mucus thinner)
- Sleep on propped up pillows, to keep the mucus from collecting at the back of your throat
- Nasal irrigation (available over-the-counter)
- An oral decongestant, such as pseudoephedrine (as in Sudafed) or phenylephrine (as in Sudafed PE or Neo-Synephrine)
- Guaifenesin (as in Mucinex), a medication that can thin the mucus
- An antihistamine, such as
- diphenhydramine, as in Benadryl
- chlorpheniramine, as in Chlor-Trimeton
- loratadine, as in Claritin or Alavert
- fexofenadine (Allegra)
- cetirizine (Zyrtec)
- levocetirizine (Xyzal)
- desloratadine (Clarinex)
- A nasal decongestant such as oxymetazoline (contained in Afrin) which constricts blood vessels in the nasal passages; this leads to less secretions. Such medications should only be taken for a day or two; longer-term use can cause more harm than good)
Keep in mind that many of these medications are combined in over-the-counter products. For example, there are several formulations of “Sudafed” containing pseudoephedrine or phenylephrine along with additional drugs including acetaminophen, dextromethorphan, and guaifenesin. While these combinations can be effective, it’s important to read the label and avoid taking too much of any active ingredient.
What about prescription treatments?
If these approaches aren’t effective, prescription treatments may be the next best steps, including:
- A nasal steroid spray (such as beclomethasone/Beconase or triamcinolone/Nasacort)
- Ipratropium (Atrovent) nasal spray which inhibits secretions (such as mucus)
Other treatments depend on the cause of the post-nasal drip. Antibiotics are not usually helpful, so they aren’t usually prescribed for post-nasal drip (unless the symptoms are due to bacterial infection of the sinuses). For allergies, dusting and vacuuming often, covering your mattresses and pillowcases, and special air filter can help reduce exposure to allergy triggers.
What about chicken soup?
If you’ve been told that chicken soup helps with post-nasal drip (or other symptoms of a cold or flu), it’s true! But it doesn’t actually have to be chicken soup – any hot liquid can help thin the mucus and help you maintain hydration.
When should I call a doctor?
In most cases, post-nasal drip is annoying but not dangerous. However, you should contact your doctor if you have:
- Unexplained fever
- Bloody mucus
- Wheezing or shortness of breath
- Foul smelling drainage
- Persistent symptoms despite treatment
The bad news/good news about post-nasal drip
Post-nasal drip is among the most common causes of persistent cough, hoarseness, sore throat and other annoying symptoms. It can be caused by a number of conditions and may linger for weeks or months. That’s the bad news. The good news is that most of the causes can be quickly identified and most will improve with treatment.
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Sore Throat & More From Sinus Drainage
Written by Stephanie Watson
- Mucus Colors Meaning
- What Causes Postnasal Drip?
- Postnasal Drip Symptoms
- Postnasal Drip Treatments
- Postnasal Drip Home Remedies
Postnasal drip is the accumulation of mucus in the back of the throat, which can cause a feeling of congestion, a sore throat, or a cough. It is a common symptom of conditions such as the common cold, sinusitis, and allergies. The excess mucus can be caused by inflammation or swelling of the nasal passages, which can be due to a variety of factors such as viral or bacterial infections, allergies, or irritants in the air.
Every day, glands in the linings of your nose, throat, airways, stomach, and intestinal tract produce mucus. Your nose alone makes about a quart of it each day. Mucus is a thick, wet substance that moistens these areas and helps trap and destroy foreign invaders like bacteria and viruses before they cause infection.
Normally, you don’t notice the mucus from your nose because it mixes with saliva, drips harmlessly down the back of your throat, and you swallow it.
When your body produces more mucus than usual or it’s thicker than normal, it becomes more noticeable.
The excess can come out of the nostrils — that’s a runny nose. When the mucus runs down the back of your nose to your throat, it’s called postnasal drip.
Yellow mucus can indicate a bacterial infection in the nasal passages. This type of infection often requires antibiotics to clear up. If the yellow color is accompanied by thick and discolored nasal discharge, it may be a sign of a sinus infection.
Green mucus can be a sign of a more severe viral or bacterial infection. The green color is caused by the presence of white blood cells that are fighting the infection. If the green mucus is accompanied by other symptoms such as fever, it is important to see a doctor for treatment.
Clear mucus is normal and indicates that the nasal passages are healthy. It is the body’s way of trapping dust, dirt, and other particles from entering the lungs. Clear mucus is also seen in the beginning stages of a cold or allergy and is often the sign that the body is fighting off an infection or irritation.
White mucus is also normal, and can be a sign that the body is producing a thicker mucus in response to an irritation or infection. It can also be caused by dry air or exposure to irritants such as smoke or pollution.
Brown mucus can be a sign of exposure to pollution or smoking. It can also be caused by the presence of dried blood, which can occur from blowing the nose too hard. If the brown color is accompanied by other symptoms, it is important to see a doctor to rule out any serious conditions.
Black mucus is not a common color and can be a sign of exposure to very high levels of pollution or smoke. It can also indicate a fungal infection. If the black color is accompanied by other symptoms, it is important to see a doctor for treatment.
Red mucus can be a sign of bleeding in the nasal passages. This can occur from blowing the nose too hard or from a more serious condition such as cancer. If the red color is accompanied by other symptoms, it is important to see a doctor for treatment.
The excess mucus that triggers it has many possible causes, including:
- Allergies, also called allergic postnasal drip
- Sinus infection or sinusitis, which is an inflammation of the sinuses
- Object stuck in the nose (most common in children)
- Certain medications, including some for birth control and blood pressure
- Deviated septum, which is the crooked placement of the wall that separates the two nostrils, or some other problem with the structure of the nose that affects the sinuses
- Changing weather, cold temperatures, or really dry air
- Certain foods (for example, spicy foods may trigger mucus flow)
- Fumes from chemicals, perfumes, cleaning products, smoke, or other irritants
Sometimes the problem is not that you’re producing too much mucus, but that it’s not being cleared away. Swallowing problems can cause a buildup of liquids in the throat, which can feel like postnasal drip. These problems can sometimes occur because of a blockage or conditions such as gastroesophageal reflux disease, also known as GERD.
Postnasal drip makes you feel like you constantly want to clear your throat.
It also can trigger a cough, which often gets worse at night. In fact, postnasal drip is one of the most common causes of a cough that just won’t go away.
Too much mucus may also make you feel hoarse and give you a sore, scratchy throat.
If the mucus plugs up your Eustachian tube, which connects your throat to your middle ear, you could get a painful ear infection.
You could also get a sinus infection if those passages are clogged.
Postnasal drip and nausea
Nausea is not a typical symptom of postnasal drip, but it can be associated with it in some cases. When mucus accumulates in the throat, it can cause a feeling of congestion and discomfort, which may lead to nausea.
Additionally, some people may experience nausea when taking certain medications used to treat postnasal drip symptoms such as decongestants. These medications can cause stomach upset and may lead to nausea in some individuals. If you are experiencing nausea while taking these medications, it is important to speak with your doctor about alternative treatment options.
How you treat postnasal drip depends on what’s causing it. Antibiotics can clear up a bacterial infection. However, green or yellow mucus is not proof of a bacterial infection.
Colds can also turn the mucus these colors, and they are caused by viruses, which don’t respond to antibiotics.
Antihistamines and decongestants can often help with postnasal drip caused by sinusitis and viral infections. They can also be effective, along with steroid nasal sprays, for postnasal drip caused by allergies.
The older, over-the-counter antihistamines, including diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton), might not be the best choices for postnasal drip. When they dry out mucus, they can actually thicken it.
Newer antihistamines like cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), levocetirizine (Xyzal), and loratadine (Claritin, Alavert), may be better options and are less likely to cause drowsiness. It’s a good idea to check with your doctor before taking these because all of them can have side effects that range from dizziness to dry mouth.
Another option is to thin your mucus. Thick mucus is stickier and more likely to bother you. Keeping it thin helps prevent blockages in the ears and sinuses. A simple way to thin it out is to drink more water.
Other methods you can try include:
- Take a medication such as guaifenesin (Mucinex).
- Use saline nasal sprays or irrigation, like a neti pot, to flush mucus, bacteria, allergens, and other irritating things out of the sinuses.
- Turn on a vaporizer or humidifier to increase the moisture in the air.
For centuries, people have treated postnasal drip with all kinds of home remedies. Probably the best known and most loved is hot chicken soup.
While it won’t cure you, hot soup or any hot liquid might give you some temporary relief and comfort. It works because the steam from the hot liquid opens up your stuffy nose and throat. It also thins out mucus. And because it’s a fluid, the hot soup will help prevent dehydration, which will make you feel better, too.
A hot, steamy shower might help for the same reason.
You can also try propping up your pillows at night so that the mucus doesn’t pool or collect in the back of your throat. If you have allergies, here are some other ways to reduce your triggers:
- Cover your mattresses and pillowcases with dust mite-proof covers.
- Wash all sheets, pillowcases, and mattress covers often in hot water.
- Use special HEPA air filters in your home. These can remove very fine particles from the air.
- Dust and vacuum regularly.
Call your doctor if the drainage is bad smelling, you have a fever, you’re wheezing, or your symptoms are severe or last for 10 days or more. You might have a bacterial infection.
Let your doctor know right away if you notice blood in your postnasal drip. If medication doesn’t relieve your symptoms, you might need to see an ear, nose, and throat specialist (also called an otolaryngologist) for evaluation. Your doctor might want you to get a CT scan, X-rays, or other tests.
causes, symptoms and treatment in adults
- Causes of postnasal drip
- Symptoms of post-nasal drip
- How to treat postnasal drip syndrome
Surely you have come across a very strange cough: during the day it does not manifest itself, but at night there is a constant desire to clear your throat, which interferes with a good sleep. This is due to the fact that the discharge from the nasal cavity flows down the back of the throat. The mucous membrane of the larynx is irritated. This is how coughing comes about. This condition in adults is called postnasal drip.
Why does postnasal drip syndrome develop and how to get rid of it?
The syndrome often develops due to pathologies of the nasopharynx (cysts, deviated septum) or an allergic reaction. It can also be the result of diseases of the gastrointestinal tract. For example, in gastroesophageal reflux disease (GERD), the contents of the stomach enter the nasopharynx, resulting in irritation of the mucous membrane.
But the most common cause of post-nasal drip is SARS. Viruses irritate the nasal mucosa – inflammation begins, swelling develops. In order to independently “cleanse” itself of microbes, the mucosa begins to intensively produce mucus. If the nose is not cleared, secretions will run down the back of the throat.
There are also factors that are not the direct cause of this condition, but contribute to its development. These are smoking, constant inhalation of dry air, dust, volatile chemicals, hormonal disorders, taking certain drugs (for example, abuse of vasoconstrictor drops).
Cough is not the only manifestation of postnasal drip syndrome. It is also characteristic:
- Sensation of a “lump” in the throat.
- Burning and dryness in nose, throat.
- Voice change. He becomes nasal, as if the person speaks dully, “in the nose.”
At night, a person cannot clean his nose as often as during the day, so the cough gets worse at this time. The situation is also aggravated by the lying position, due to which the discharge from the nose does not flow out, but flows down the larynx. And in the morning, it is difficult for a person to breathe and swallow normally until he coughs and clears his nose.
If the syndrome is a consequence of ARVI, then the symptoms characteristic of a cold are added to the listed symptoms: runny nose, discomfort in the throat, headache and muscle pain, fever.
If you wake up at night with a cough caused by post-nasal drip, you should thoroughly gargle, you can even with plain warm water, rinse your nose and clear the nasal passages of mucus. After that, you can drink a warm, non-acidic drink, suck on a lozenge or cough lozenge. This will help reduce irritation of the throat mucosa.
Treatment of postnasal drip syndrome in adults is limited to the elimination of the cause of this condition. In most cases, drug therapy is needed. So, for allergies, the patient is prescribed antihistamines, and for GERD, drugs that neutralize hydrochloric acid and reduce its production in the stomach. Surgical intervention is usually resorted to in case of anomalies of the nasal cavity (removal of a cyst, correction of a deviated septum).
If post-nasal drip is caused by SARS, then the first thing to do is to fight the pathogens. It is also necessary to remove the swelling of the mucous membrane, to normalize its condition.
Passive inhalations with Breathing Oil® will help to destroy viruses and bacteria in the inhaled air, disinfect the respiratory tract. It is a composition of six pure essential oils with antiviral, antibacterial and anti-inflammatory properties. Dyshi® oil not only stops the reproduction of microorganisms, but also reduces swelling of the nasal mucosa and the amount of discharge from the nose, which helps to eliminate postnasal drip syndrome. Also, the use of this composition of essential oils accelerates recovery and reduces the number of complications in acute respiratory viral infections.
To reduce swelling, moisturize and soothe the mucosa will help rinsing the nose with solutions of sea water. Washing also contributes to the mechanical cleansing of the mucosa: the solution “washes” viruses and bacteria from it. Usually the effect of the procedure lasts for four hours, but passive inhalations with Dyshi® Oil can prolong it.
Use vasoconstrictors with caution. They can be addictive, which, as we noted, is a factor that provokes postnasal drip syndrome.
Take antiviral drugs and antibacterial agents only after consulting a doctor.
In addition, it is important to maintain in the room where the patient spends time, the optimum temperature (19-21 ° C) and humidity (40-60%). To do this, you need to ventilate the room at least twice a day (for at least 15 minutes), and also use humidifiers.
Humidify the mucous membrane of the throat will help and plentiful warm drink – water, non-acidic and unsweetened fruit drinks, compotes, weak tea.
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New approaches to the treatment of cough associated with “post-nasal drip syndrome”
Cough is one of the most common complaints that cause visits to a doctor. The reason for the appeal, as a rule, is a painful cough that disrupts the quality of life of patients, or the appearance of other symptoms that disturb the patient along with the cough.
However, coughing is a normal reaction of the respiratory tract to various irritants. Cough serves as a defense mechanism to help clear the airways of excess secretions and foreign particles. Only a long-term unproductive paroxysmal cough is a pathology.
Cough is a complex reflex that has afferent pathways from the cough receptors of the sensory endings of the trigeminal, glossopharyngeal, superior laryngeal and vagus nerves to the “cough center” in the brain stem and an efferent link of the reflex, including the recurrent, laryngeal nerve and spinal (C1 and C4) nerves . Cough can occur with inflammatory, chemical and thermal irritation of cough receptors. It also happens in healthy people. By its nature, a cough is a sharp push of air from the lungs through the opening of the glottis. Cough begins with a deep breath, after which the glottis closes and the respiratory muscles contract. Due to the synchronous tension of the respiratory and auxiliary muscles, when the glottis closes, intrathoracic pressure increases and the trachea and bronchi narrow. When the glottis opens, a sharp pressure drop creates a rapid air flow in the narrowed airways, entraining mucus, foreign particles, and thus stimulates the cleansing of the bronchi. This is especially important when the natural cleansing mechanism is disturbed, for example, in smokers.
Cough may provide other services to a person by being a factor that can keep the patient conscious during life-threatening arrhythmias and / or help restore a normal heart rhythm.
The nature of the cough can be productive (wet, with sputum) and unproductive (dry).
To establish the correct diagnosis and select adequate therapy, it is necessary to determine the cause of the cough. To do this, you need to evaluate all the characteristics of the cough. Each of them has a certain diagnostic value. However, the answer to the first question that the doctor asks the patient, “How long ago did the cough start?”, suggests the cause of its occurrence.
Acute cough. The most common causes of acute cough are upper respiratory tract infections such as acute respiratory viral infection (ARVI), acute bacterial sinusitis, whooping cough, exacerbation of chronic obstructive pulmonary disease, allergic rhinitis. Viral infections of the upper respiratory tract are the most common cause of acute cough. In patients with ARVI, in the absence of treatment, the frequency of this symptom in the first 48 hours of the disease reaches 83%, and by the 14th day it decreases to 26%. Cough in ARVI is stimulated by drainage of discharge from the nasopharynx and irritation of the mucous membrane of the larynx. With adequate therapy for ARVI, the cough disappears without a trace. However, there are situations when the cough acquires a protracted course.
Prolonged cough. Most often begins with an upper respiratory tract infection and lasts 3 to 8 weeks, most often it is the so-called “post-infection”, or is a manifestation of bacterial sinusitis or asthma.
Chronic cough. A common cause of chronic cough is smoking, which has a direct irritant effect on the cough receptors of the respiratory tract, and also causes irritation and inflammation of the mucous membrane of the tracheobronchial tree. Other causes of chronic cough are:
1. Syndrome of post-nasal mucus leakage into the pharynx due to rhinitis or sinusitis. The term “postnasal drip syndrome” refers to clinical situations characterized by an inflammatory process in the upper respiratory tract (nasopharynx, nose, paranasal sinuses), in which nasal discharge flows down the back of the pharynx into the tracheobronchial tree. Physicians’ awareness of this syndrome is important because cough in this condition is not always correctly interpreted and is often misattributed to chronic bronchitis. This syndrome occurs in 20-34% of patients with chronic cough.
2. A special variant of bronchial asthma, which is manifested by cough without suffocation, more often at night. The so-called “cough bronchial asthma” accounts for 20-28% of all cases of chronic cough.
3. Gastroesophageal reflux (gastroesophageal reflux disease). It is believed that in more than 20% of patients with chronic cough, the cause of the latter is gastroesophageal reflux.
4. Cough often becomes a side effect when taking angiotensin-converting enzyme (ACE) inhibitors in the treatment of patients with arterial hypertension and circulatory failure. This is due to the accumulation of bradykinin, which adversely affects the bronchi. It is noted that not all ACE inhibitors equally have this side effect. Much less often, cough occurs when using pyrindopril (prestarium) and monopril.
In most cases, the occurrence of cough is associated with the pathology of the respiratory system. However, there are such types of it in which there is no pathology in the respiratory tract. This is a reflex and neurogenic cough.
In the treatment of cough, it is necessary to take into account its etiology, course and nature.
The most effective is etiotropic therapy, which involves either eliminating the cause of coughing (cancellation of drugs that cause coughing, smoking cessation, removal of sulfuric plug from the external auditory canal, elimination of contact with the allergen, etc. ), or elimination of the pathological process that led to coughing ( antibacterial therapy of pneumonia and other respiratory infections, treatment of gastroesophageal reflux, etc.). In cases where etiological and pathogenetic therapy for one reason or another is impossible or not effective enough, symptomatic cough therapy is carried out. The choice of drugs in this case depends primarily on the nature of the cough, its intensity and other features.
According to the mechanism of action, antitussive drugs are divided into central narcotic (codeine) and non-narcotic (glaucine) drugs that cause inhibition of the cough center, and peripheral drugs that reduce the sensitivity of cough receptors (local anesthetics, combined drugs and drugs that suppress the release of antipsychotics.
An important pathogenetic mechanism of bronchial obstruction is the formation of viscous sputum that is difficult to separate. Liquefaction and removal of this secret is essential in the treatment of cough. Drugs that affect the formation of sputum can be divided into 4 groups.
1. Drugs with a reflex action, realizing their effect from the gastric mucosa (thermopsis) and through the chemoreceptor trigger zone (apomorphine). They irritate the afferent fibers of the parasympathetic nerve and the gastric mucosa, which reflexively excites the respiratory center. As a result, stimulation of the bronchial glands occurs, which, in turn, contributes to the evacuation of sputum.
2. Medicines with direct action on the mucous membrane of the respiratory tract (salt, alkali, essential oils). Among them, iodides are the most widely used. Being released from the blood, iodine salts cause hyperemia of the bronchial mucosa, stimulate the bronchial glands, and therefore the sol layer becomes more liquid.
3. Proteolytic enzymes.
4. Stimulants of surfactant products (ambroxol and its derivatives).
In case of incompetent cough in debilitated patients, agents that increase cough and sputum excretion are used.
Despite the variety of antitussives, the search for new, effective and safe drugs remains very relevant. The aim of our study was to determine the effectiveness of the treatment of cough caused by “postnasal drip syndrome”. Medicinal plants such as primrose flowers, sorrel grass, elder flowers, verbena grass, gentian root have long been used in medicine for the treatment of respiratory diseases. It is these medicinal plants that are part of the drug synupret (“Bionorica Arzneimittel”), which was developed more than 60 years ago and has a long history of practical use. Sinupret is a complex drug with a unique selection of combinations of medicinal plants. The drug was created using a special production technology – phytoneering, which achieves the maximum concentration of active ingredients with minimal allergenicity, good tolerance and a high safety profile. Due to the five-component composition, synupret has a secretolytic, anti-inflammatory, antiviral and immunomodulatory effect, proven in clinical studies [1-3]. Sinupret effectively regulates secretion and normalizes mucus viscosity, eliminates mucostasis and restores mucociliary clearance. A decrease in the viscosity of the secret occurs due to the stimulation of the secretory cells of the mucous membrane of the upper respiratory tract, which produce neutral mucopolysaccharides. Sinupret has an anti-inflammatory and anti-edematous effect on the mucous membrane, inhibiting the synthesis of pro-inflammatory mediators  and reducing swelling in the region of the paranasal sinuses. Sinupret also improves the drainage of the paranasal sinuses and facilitates nasal breathing. Studies  have shown that, during treatment with Sinupret, there is an increase in the activity of nonspecific protective factors and an increase in local immunity of the mucous membranes: a significant increase in the phagocytic number, levels of sIgA and lysozyme in saliva, and an increase in the concentrations of Ig M and Ig A in blood serum. At the same time, an increase in the activity of antiviral immunity was revealed due to an increase in the production of a mixture of IFα + IFγ. These properties of the drug significantly reduce the manifestations of the “postnasal drip syndrome”, which occurs as a result of acute and chronic rhinosinusitis of both viral and bacterial origin, and the cough provoked by it.
We conducted a study of 40 patients. They were divided into two groups of 20 people. The 1st (explored) group consisted of 12 men and 8 women aged 19 to 66 years (mean age 42 years). Patients of this group suffered from acute and exacerbation of chronic rhinosinusitis, accompanied by cough. All patients were treated with Sinupret 50 drops 3 times a day. In the 2nd group, similar in qualitative and quantitative composition, there were 10 men and 10 women aged 20 to 63 years (average age 42 years). Patients of this group were prescribed tableted drug Thermopsis 1 tablet 4 times a day.
Table shows that on the 6th day in the group of patients using Sinupret, the cough decreased from 206 points to 16 points, while in the control group using thermopsis, the cough decreased from 221 points to 64 points, i.