Chronic Post Nasal Drip

If chronic post nasal drip best describes the problem several things come to mind. 

Nasal source 

Sometimes one or more of the posterior sinuses (sphenoid or posterior ethmoid) can become chronically infected without causing other nasal symptoms. Infection can also develop on the surfaces of the nasopharyx, which is the adenoid region. The drainage from this problem is irritating and usually creates a characteristic redness in the back of the throat that can be seen on physical examination. If patients fit this pattern, they should see a specialist. 

If chronic infection is suspect, the first step is usually to treat chronic sinusitis with prolonged broad spectrum antibiotics and steroid sprays or pills. If allergies are suspected, antihistamines or steroid nasal sprays are tried. 

If a nasal source is highly suspect, and the diagnosis remains unclear, a CT scan of the sinuses is often obtained.  

Non-nasal source 

People think of chronic infection and allergy as the primary sources for PND. If PND is chronic and not associated with many other nasal symptoms, I think that it is much more common for it to be secondary to LPR = (Laryngo-pharyngeal reflux). This is a form of acid reflux that primarily affects the voice box area. 

People rarely believe this at first, usually because they haven't considered it before and they may not have any heart-burn or indigestion. 

The symptoms of LPR include one or more of the following and differ from patient to patient. Surprisingly, heart burn and indigestion are not usually present. 


Common symptoms of LPR 

A feeling of thick mucous in the throat 
A feeling of a lump in your throat when you swallow, especially when swallowing "dry" 
Hoarseness or a voice that fatigues easily 
Chronic cough or throat clearing 
Chronic sore throat, low in throat near voice box 
Waking up choking or with burning 
More likely if overweight or snore loudly or if you have sleep apnea 


What to do if this describes your problem? 

If the problem is severe or seems to be getting worse, you should see a specialist. An endoscopic exam of your larynx can help rule out the unlikely possibility of a throat cancer, and can provide information that can substantiate the LPR diagnosis, or perhaps suggest a different diagnosis. If the problem is likely to be LPR, the next "test" is to treat with high dose antacids, and see if there is any relief from the symptoms. If the doctor thinks that it is more likely a chronic infection, then a course of specially selected antibiotics will possibly be given or a culture of the nasopharynx can be done to identify the possible bacteria. If improvement isn't found, a CT scan may be helpful. 


If you want to try and treat this yourself for a while, I would start by using saline nasal rinses and also high doses of antacids. Not just any antacid. It is well appreciated that treatment of LPR can be difficult and the results can be slow to come. You should get Prilosec OTC® and take 2 of them in the morning, and 2 of them in the evening. I would recommend taking them at this rate for at least 2 weeks and probably for 4 weeks before drawing any conclusions. This type of medicine is expensive, even the OTC form. 

Proton pump inhibitors, PPIs, like Prilosec, have a good safety record in general but recent studies raise some questions about long term use. The usual full prescription dose is the same as 2 of the OTC form, taken only once a day. Using this medicine twice a day is "off label", but it is frequently needed to get control of symptoms in patients with LPR, especially at the beginning treatment.   Prilosec and others like it need to be taken about 30 minutes before a meal.  They are less effective if taken at other times.

The first month on antacids should be considered a test. Most often this therapy is begun on an "educated guess". One of the best ways to finish the diagnosis of LPR, is to get a good response from acid control medicines. It is best to begin treatment with the best medicines, given in higher doses. Usually, once the symptoms have resolved, a lower dosage is effective to keep symptoms from coming back.