Post-Nasal Drip

Glands in your nose, sinuses, and throat continually produce mucus (one to two liters a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders.

This sensation may be bothersome because the secretions are excessive, are thicker than normal, or when there is increased glandular tissue, particularly at the bottom of the throat that leads to a full feeling in the throat, often described like a ball in the throat (globus sensation).  This is a very common symptom seen by ear nose & throat doctors.  It can also be due to actual swallowing problems.

Excessive secretions can occur in response to nasal and sinus irritation, temperature changes, allergies, foods/spices, pregnancy and hormonal changes.  In the absence of sinusitis, this is termed rhinitis.  There are several types of rhinitis.  Fortunately, most of them are not serious but can be a nuisance and even an embarrassment.  Thick secretions are often due to excessive drying or poor humidification by the natural humidifiers in your head, your sinuses.  Some individuals react to certain foods, dairy as an example, with excessive thickening of their phlegm.

Sometimes there are no excess secretions found and it can be gleaned that normal secretions may not be flowing normally due to actual functional swallowing issues (dysphagia).  The act of swallowing is a highly complex event requiring the interaction and coordination of many muscles and nerves.  Neuromuscular conditions as well as age related changes can affect the normal steps of swallowing that can lead to actual difficulty swallowing liquids and/or solids or the sensation that your saliva is not flowing correctly.  These tend to be the more concerning problems associated with symptoms of postnasal drip.  Other complaints include throat clearing, coughing, hoarseness, and in the most serious conditions, wheezing and pneumonia due to aspiration into the trachea.

One of the most commonly diagnosed problems, particularly in the absence of other findings is gastroesophageal reflux disease (GERD).  This refers to the backflow of stomach acids and juices into the esophagus and/or throat.  Heartburn and indigestion are common symptoms of esophageal irritation.  When the backflow reaches the level of the throat and voicebox (supraesophageal or laryngopharyngeal reflux), the tissues react by increasing secretion of saliva as a protective response.  This can lead to excessive throat clearing that can lead to additional irritation.   When this is suspected, particularly in the absence of other findings, trials of medications to reduce the acid are usually prescribed before more extensive evaluation is undertaken.  If there are other findings, these may need to be treated simultaneously.