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The glands in your nose and throat continually produce mucus (one to two quarts a day). The mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. The mucus can be rich in immune proteins and debris that has been brought out of your sinus cavities. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.
What Causes Abnormal Secretions – Thin and Thick
Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bone dividing wall that separates the two nostrils). The most concerning abnormal thin secretion emanating from the nose is called cerebrospinal fluid rhinorrhea. This occurs when the cushioning fluid surrounding the brain leaks through a defect in the bone of the roof of the nose or a nearby structure drips into the nose after a fracture, nasal or facial surgery, or, rarely, without an identifiable cause. CSF rhinorrhea is usually a constant clear nasal dripping and can often be salty and bitter to the taste. It may be accompanied by positional headaches or subtle fluctuations in mental state.
Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is possible that a bacterial sinus infection is developing. It is important to realize that not all colored nasal secretions correlate with a nasal infection, however. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.).
Vasomotor Rhinitis describes a nonallergic “hyperirritable nose” that feels congested, blocked, or wet. It may be aggravated by cold weather exposure or exercise. A similar and related condition, gustatory rhinitis, occurs when a patient is eating and is particularly aggravated by spicy or hot foods.
Treatment For Post-Nasal Drip
A correct diagnosis requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies. Each treatment is different:
Bacterial infection, when present, is treated with antibiotics. These drugs may provide only temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required. Sometimes, other types of nasal surgery will be recommended for persisting and stubborn nasal drainage, including turbinate or septum surgery.
Allergy is managed by avoiding the cause if possible. Antihistamines and decongestants, steroid nasal sprays, and other forms of steroids may offer relief. Immunotherapy (allergy shots) also may be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays generally may be used safely under medical supervision.
General measures for thinning secretions so they can pass more easily may be recommended when it is not possible to determine whether an existing structural abnormality is causing the post-nasal drip or if some other condition is to blame.
Many people, especially older persons, need more fluids to thin secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (fluid pills) will help. Mucous-thinning agents such as guaifenesin (MucinexÆ) may also thin secretions.
Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day with as simple a device as possible to prevent contamination of the irrigation system itself. Several devices for doing this can be found at your local pharmacy or supermarket. A clear plastic syringe will also work very well. . Warm water with baking soda and non-iodized salt (1/2 to 1 tsp. to the pint for each). Finally, use of simple saline (salt) nonprescription nasal sprays (e.g., Ocean, NeilMed Sinus Rinse) to moisten the nose is often very beneficial.
Sources:
Jeffrey L. Cutler, M.D.
Dr. Jeffrey Cutler is board-certified with the American Board of Otolaryngology and received his medical degree at Tulane University Medical School in New Orleans. He performed his residency at Vanderbilt University Medical Center in Nashville. In addition, he completed a 1 year fellowship in nasal and endoscopic sinus surgery. His area of expertise includes the medical and surgical treatment of complicated sinus and skull base diseases. Dr. Cutler has published many articles on office based nasal and sinus procedures - particularly on balloon sinus and Eustachian tube dilation When not at the office, he enjoys spending time outdoors with his family, skiing and cycling.
