Post-nasal drip

Post-nasal drip (PND) is a condition characterised by excessive mucus production from the nasal mucosa, leading to mucus accumulation in the nasopharynx or oropharynx. This often results in chronic cough, throat irritation, and halitosis. PND is frequently associated with conditions such as allergic rhinitis, sinusitis, and gastro-oesophageal reflux disease (GORD).

Pathophysiology

• PND occurs when the nasal mucosa produces excess mucus, which then drains posteriorly into the pharynx
• This can be due to inflammation, infection, or irritants
• The presence of mucus in the throat can trigger the cough reflex and lead to throat irritation.

Clinical presentation

• Chronic cough
• Throat clearing
• Halitosis
• History: Focus on duration of symptoms, associated features (e.g., nasal congestion, heartburn), and potential triggers (e.g., allergens)
• Examination: Inspect the nasal cavity for signs of inflammation, polyps, or discharge. Assess the oropharynx for mucus pooling.

Management is directed at the underlying cause:

• Allergic rhinitis: Consider antihistamines and intranasal corticosteroids.
• Chronic sinusitis: Treat with nasal saline irrigation and consider referral for further evaluation if symptoms persist.
• GORD: Advise lifestyle modifications and consider proton pump inhibitors if appropriate.
• Referral to ENT should be considered if symptoms are refractory to initial treatment or if structural abnormalities are suspected.