By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Postnasal drip is a condition wherein you feel as if mucus is dripping back of your nose and throat. This excessive mucus is caused by the glands in these areas. The mucus is constantly produced by the nose, throat and sinuses. There is an urge to clear the throat often in people suffering from this condition.
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The glands in the nose and throat produce mucus as part of defense mechanism, most often for one of the above said reasons –
– To fight against the infection
– To filter off all the foreign matter entering the nose
– To moisten nasal membranes and protect it from cold and dryness
When postnasal drip occurs, the person would swallow the mucus without his knowledge. Often there is ‘difficulty to blow’ the nose and clear the nose of its secretions and hence compelled to pull them up and back into the throat. If the person is awake, he can spit it off but when sleeping the mucus may enter the stomach due to swallowing.
Read more about Postnasal drip
- Feeling of mucus dripping down the back of the throat
- Itching sensation in the throat
- Frequent throat clearing or feel to do so
- Feeling to constantly swallow
- Excessive spitting/swallowing of mucus
- Cough – gets worse at night
- Foul breath
- Allergies of various kinds like hay-fever
- Seasonal allergies due to plants releasing their pollen and consequent inhalation of the same
- Cold weather / dry air – When one breathes cold or dry air, they cause irritation of the nose and throat. As a consequence, excessive mucus is produced due to this irritation so as to humidify and create warmth in the breathing passages and to counteract the irritation caused therein.
- Viral infections – like flu, common cold, sinus infections are associated with cold weather which cause post nasal drip apart from many other symptoms.
- Excessive mucus is produced by the body as a part of the reaction towards invading microorganisms, so as to flush them out.
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Other causes include
Foreign objects impacted in the nose
Exposure to smoke and dust
Chronic respiratory conditions like COPD
Exposure to irritating chemicals from fumes, perfumes and cleaning products
Excessive consumption of overly spicy foods
Medications – birth control pills, medicines for hypertension etc
In some cases it is the inability of throat to clear the excessive mucus which causes postnasal drip.
Some conditions which cause build up of liquids in throat and cause symptoms similar to postnasal drip are gastric reflux and swallowing problems.
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Right time to see the doctor
One should see the doctor if the symptoms are troublesome for more than 10 days or 2 weeks. Sometimes complications occur if this condition is not treated promptly. There may be a possibility of infection of the nose and sinuses. The infection may also spread to involve Eustachian tube (tube which connects your throat with middle ear). Treating postnasal drip earlier would prevent complications.
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Other conditions –
- having discolored mucus which doesn’t clear up
- presence of foul-smelling mucus
- symptoms of postnasal drip associated with fever which doesn’t reduce
- symptoms persisting for more than 10 days
Prevention of postnasal drip
- reduce exposure to allergens
- regularly take medicines for allergy
- keep your home and workplace free of dust and dirt
- protect self from dust mites by using mattress and pillow covers
- keep changing air filters on air conditioners, ventilation and heating equipment
- take shower before going to bed
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1. Medicines to dry out the mucus / decongestant
2. Medicines to thin the mucus
Other measures to thin the mucus –
Increase the moisture in the air to thin the postnasal secretions, this allows easy movement of mucus through the passageways
Humidifiers or steam vaporizers
3. Antibiotics – Mucus with strong or foul smell, fever, wheezing indicates bacterial infection. This may need antibiotics.
4. Surgery – DNS may require surgical intervention (septoplasty).
5. Addressing other issues – If postnasal drip is caused by GERD, acid reflux or trouble swallowing, medications should be given to combat these conditions.
6. Nasal Sprays – Saline sprays / irrigation pots in which salt water is used to flush out the mucus which has built up behind the nose helps in postnasal drips. This will help in clearing blocked airways and also reduce mucus.
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Tips to try at home
Head elevation – while sleeping at night will help if the symptoms get worse at night. Propping pillows beneath the head and shoulders would promote mucus drainage. It also would reduce the amount of mucus in the throat and airways.
Fluids – Hydration on a regular basis helps to make the mucus thin and enables it to flow smoothly. It also prevents dehydration associated with post nasal drip.
Herbal Tea – Warm herbal tea may provide relief from sore throat.
Steaming – will help in clearing the mucus accumulations and help in clearing the sinuses.
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The best way to treat it is to keep away from known allergens or any known triggers which could make things worse. Many times, postnasal drip clears up all by itself without any treatment.
Over the counter medications and home remedies will help to some point until the condition becomes chronic and stubborn. If the condition is persistent or is associated with symptoms which worsen the condition should see the doctor as soon as possible. Prompt diagnosis and appropriate treatment would help in curing and preventing postnasal drip.
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Ayurveda Understanding of Postnasal Drip
Symptoms resembling those explained in Post Nasal Drip are found in many diseases explained in Ayurveda texts. They shall be considered as the differential diagnosis of postnasal drip from Ayurveda perspective.
1. Nasanaha / Nasa Pratinaha –
Nasa Pratinaha is a condition where there is obstruction in nasal cavity and difficulty in breathing through the nose. This is caused by vitiated kapha in association with vitiated vata. Here kapha is involved in the pathogenesis, just like there is accumulation of lot of mucus at the back of your nose in postnasal drip.
Similar mechanism happens in the pathogenesis of another condition called Nasanaha explained by Vagbhata. Both these are considered to be different explanations of the same condition. In Nasanaha patient feels as if the nose is filled up and stuffed with something. In this condition the person feels difficulty in breathing and feels as if the nose has been blocked forever.
Another similar condition is explained by Master Sushruta and it is named as Nasa Pratinaha. Sushruta additionally mentions the stickiness of nasal passages and gluing of nasal walls. These conditions are compared to hypertrophy of turbinate or deviated nasal septum (DNS) which are causes of postnasal drip.
Read – Nasanaha: Meaning, Symptoms, Treatment, Modern Correlation
2. Pinasa / Apinasa
It is a nasal disorder which manifests independently or as a consequence of pratishyaya. Both terms Pinasa and Pratishyaya are also used interchangeably and are also considered synonyms of each other.
Master Vagbhata has explained a condition named Avinasa, which sounds like pinasa and apinasa. In this condition the patient’s nose gets stuffy and filled with more phlegm like in the nose of a sheep. This condition definitely reflects and resembles the explanation of the symptoms of postnasal drip.
Apinasa is caused by vitiated vata and kapha and one of the symptoms include stuffy nose. In Avinasa the increased kapha in the nose blocks the nasal passages. But there are discharges in this condition which keeps the nose moist always.
There are 2 stages of pinasa. The first stage of the disease is unripe form and comprises discharges along with other symptoms. But the second stage, which is the ripe stage of the disease, is very important in this discussion. In the ripe stage the mucus or secretions in the nose get thickened and block the nasal passages. This resembles the symptoms of postnasal drip.
Read – Pinasa – Meaning, Symptoms, Treatment
3. Tamaka Shwasa
Tamaka Shwasa is one of the 5 types of breathing disorders. It is often compared to Chronic Bronchitis or Bronchial Asthma. COPD is one of the causes of postnasal drip.
In the pathogenesis of tamaka shwasa, Master Charaka mentions the chronology of formation of pinasa (compared to postnasal drip) followed by dyspnea followed by cough.
Read – Shwasa Roga Chikitsa: Ayurvedic Treatment, Medicines
Postnasal drip shall be treated on the lines of treating one or more of the below mentioned conditions –
Nasanaha / Nasa Pratinaha
Pinasa / Apinasa / Avinasa
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Chronic cough is related to postnasal drip. When chronic cough is evaluated PND is found to be the cause in some cases if not all. Actually the studies show that the pathophysiology of the disease doesn’t lead to chronic cough. Cough from PND may be due to airway sensory hypersensitivity against irritation from inflamed nasal secretions. Pinasa is one of the symptoms of cough of kapha origin (kaphaja kasa). Pinasa can be compared to postnasal drip symptoms. According to Ayurveda cough and pinasa can coexist.
Similar Study – PND and chronic cough – an open interventional study
American Catarrh and Rhinosinusitis – Postnasal drip Syndrome, 200 years of controversy between UK and USA – Postnasal drip syndrome (PNDS) was a common condition in the UK in the 19th century. It was also prevalent in the USA and was popularly known as ‘American Catarrh’. PNDS was considered as one of the most common causes of chronic cough by American chest physicians while this hypothesis was not accepted by UK chest physicians. They in fact used the term Rhinosinusitis instead of PNDS. Current research on treating excessive airway mucus in lower airways may be applicable to PNDS.
Gastric reflux and sino-nasal disease – There are more than 60+ original studies which establish a link between gastric reflux and sino-nasal disease.
Relation of PND with pharyngitis – There is an interesting study wherein the postnasal drip has been studied in relation to chemical or viral pharyngitis.