Postnasal drip: sore throat and cough treatment

Postnasal drip (PND) is the abnormal production of excess mucus secretions by the nose and sinuses that may drain backwards, down into the throat. In some cases, this may produce irritation of the throat and coughing as an attempt to clear it. Leading ENT surgeon Mr Joe Marais explains the causes, symptoms and treatment options for postnasal drip. 
 

Is postnasal drip normal?

It should be understood that the production of mucus, which should drain posteriorly, is a normal and indeed essential function.

This mucus is protective, lubricates the throat and can measure up to 1.5 litres per day. It contains antibodies against germs, which become trapped in the thin layer of mucus covering the entire surface of the internal nasal passages and throat.

Sometimes what people complain about, as a “postnasal drip” or “catarrh” is simply an exaggeration of normal function.
 

What are the symptoms?

The frequently experienced symptoms of postnasal drip include irritation of the throat, the inability to clear thick, sticky secretions (especially in the mornings) and non-productive tickly cough. Sleep disruption is also common.

If there is a significant infection of the sinuses (sinusitis), the secretions may be discoloured (yellow, green, brown) and may be offensive in smell and taste. This may produce a chronically sore throat and may seriously aggravate a pre-existing chest condition such as asthma or bronchitis. Nasal blockage may co-exist (see below).
 

Who is most likely to have it?

PND can affect anybody. It is very common. Children may have it due to infection of the adenoids (glandular tissue behind the nose). Adult males and females are equally affected.

Smokers are more likely to suffer PND and anyone with chronic sinusitis. Much rarer causes include those with immune disorders, or mucus-transport disorders (e.g. cystic fibrosis) as they are more likely to suffer from sinus infections, which will cause PND.
 

What causes PND?

The possible causes of postnasal drip include:

• Enlarged and infected adenoids
• Rhinitis (nasal inflammation)
• Sinusitis and nasal polyps
• Allergies
• Nasal blockage (mouth-breathing makes secretions thick, sticky and very difficult to clear)
• Smoking
• Environmental irritants (dust, smoke, chemicals, pollution)
• Inherited/genetic immune or mucus-transport diseases (e.g. cystic fibrosis)

A common fallacy is that dairy products cause PND and this is hardly ever true!
 

How is it treated?

Treatment options for postnasal drip include:

• Elimination of irritants, smoking and allergens, where possible.
• Treatment of rhinitis with steroid nasal sprays/drops, saline irrigations, antihistamines.
• Treatment of sinusitis/polyps with antibiotics, steroids or surgery, or all three.
• Adenoidectomy.
• Nasal unblocking surgery.
• Mucolytic agents with mucus-thinning drugs.
• Increase water intake for those with sticky and tenacious secretions.

If your postnasal drip is not resolving with treatment from your GP then book an appointment to see an ENT specialist today!