Author: Dr. Nadya Serbezova, ENT Specialist
Dr. Nadya Serbezova is an Ear, Nose and Throat (ENT) specialist with over 14 years of experience in diagnosing and treating conditions of the ears, nose and throat. She graduated from the Medical University of Plovdiv in 2004 and obtained her specialty in Otorhinolaryngology in 2012 after completing a residency at the Medical Institute of the Ministry of Interior in Sofia. Since 2013 she has been practicing at Hill Clinic – Sofia, and since 2020 she has been part of the team at Acibadem City Clinic Mladost Diagnostic and Consultation Center.
Dr. Serbezova presents the topic “Postnasal Drip (Post Nasal Drip – PND)” as one of the most common complaints with which patients seek the help of an ENT specialist. Many people describe it as a sensation of “mucus dripping down the back of the throat” or “something stuck in the nasopharynx.”
“What’s interesting is that this mechanism is completely normal. Every day the nose, sinuses and throat produce about one liter of mucus. That’s why sometimes patients’ complaints about dripping sound almost as natural as complaining about yawning in the morning,” says Dr. Serbezova.
The mucus produced by the glands in the nasal mucosa serves to humidify and cleanse the inhaled air and the mucosa itself. This secretion is part of the mucociliary system, which plays a key protective role in the nose. Normally, nasal mucus is not felt because it naturally drains toward the throat, where it mixes with saliva and is swallowed unconsciously and continuously throughout the day.
This raises the question: When and why does this normal process turn into an unpleasant and irritating symptom?
What is post-nasal drip?
PND is a symptom that can accompany many different conditions. When it appears along with other specific manifestations, it is referred to as Post-Nasal Drip Syndrome (PNDS) – a broader clinical complex.
The sensation is caused by changes in the amount, consistency, or drainage of nasal secretions.
Main causes of post-nasal drip
They can be grouped into three major categories:
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Increased mucus production
Secretion increases in cases of:
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cold, flu and viral infections
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allergic rhinitis
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vasomotor rhinitis
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exposure to cold temperatures
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spicy foods
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pregnancy and other hormonal changes
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certain medications – oral contraceptives, sedatives, erectile dysfunction treatments
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irritants: cigarette smoke, perfumes, chemical fumes
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Thickening of normal mucus
Thickened secretions occur in:
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acute and chronic rhinosinusitis
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nasal polyposis
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presence of a foreign body
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certain tumors
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allergies
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cystic fibrosis
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sarcoidosis
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advanced age
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dry air, heated rooms, dusty or polluted environments
Anatomical features such as a deviated nasal septum, enlarged turbinates, or adenoid hypertrophy can also lead to retention and thickening of mucus.
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Impaired drainage and clearance of mucus
Causes include:
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advanced age
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disturbed sleep
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chronic stress
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masses or enlargements in the pharynx or esophagus
Symptoms
Symptoms of post-nasal drip vary, and not all appear in every patient. They may include a sensation of something dripping or sticking in the throat, urge to cough or clear the throat, throat irritation and pain, chronic cough, bad breath, and symptoms related to the middle ear.
Diagnosing this unpleasant condition can be challenging. On one hand, the complaints are subjective and there is no objective method to measure mucus quantity; on the other, many different conditions can cause it.
Dr. Serbezova, how is the diagnosis made?
Diagnosis is challenging due to the subjective nature of the symptoms and the lack of a method to measure secretion volume.
A comprehensive approach is required, including:
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detailed medical history
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thorough ENT examination
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laboratory and microbiological tests
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endoscopy of the nose and nasopharynx
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imaging studies (X-ray, CT scan)
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allergy testing
Treatment of post-nasal drip
The approach must be strictly individualized and directed at eliminating the underlying cause. Active patient involvement is essential.
Consultation
If any of the above-mentioned symptoms occur, it is important for the patient to seek consultation with an Ear, Nose and Throat specialist. A timely examination allows for an accurate diagnosis, identification of the underlying cause, and selection of the most appropriate treatment.
Conservative treatment
May include:
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antibiotics for bacterial infection
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nasal corticosteroid sprays
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decongestants
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antihistamines
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mucolytics
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leukotriene antagonists
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specific immunotherapy for confirmed allergies
Surgical treatment
In cases of structural or chronic issues, options include:
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septoplasty
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functional endoscopic sinus surgery (FESS)
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radiofrequency turbinate reduction
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adenoidectomy
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and other procedures depending on the specific case
Conclusion
Post-nasal drip is not a disease itself but a symptom that can accompany a wide range of conditions.
“The key to successful treatment lies in accurate diagnosis, an individualized approach, and addressing the leading cause in each patient,” emphasizes Dr. Nadya Serbezova.