Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat, and food passage (esophagus) aren't working properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough.
Several factors contribute to swallowing problems:
- With age, swallowing muscles often lose strength and coordination. Thus, even normal secretions may not pass smoothly into the stomach
- During sleep, swallowing occurs much less frequently, and secretions may gather
- Coughing and vigorous throat clearing are often needed when awakening
- When nervous or under stress, throat muscles can trigger spasms that feel like a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation
- Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids
Swallowing problems may be caused also by gastroesophageal reflux disease (GERD). This is a return of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.
Chronic Sore Throat
We encourage the awareness that post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.
Treatment for Post-Nasal Drip
A correct diagnosis requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies. Treatment varies depending on each patient’s specific need. 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.
Allergies are managed by avoiding the cause if possible. Antihistamines and decongestants, cromolyn and steroid (cortisone type) 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 non-sedating antihistamines, available by prescription only, 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. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, steroids must be monitored carefully when used for more than one week.
Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids (e.g., Maalox®, Mylanta®, Gaviscon ®) and drugs that block stomach acid production (e.g., Zantac®, Tagamet®, Pepcid®) or more powerful medications may be prescribed. A trial treatment may be suggested before x-rays and other diagnostic studies are performed.
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 (Humibid®, Robitussin®) may also thin secretions.
Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik® with a nasal irrigation nozzle. Warm water with baking soda or salt (1/2 to 1 tsp to the pint) or Alkalol®, a nonprescription irrigating solution (full strength or diluted by half warm water), may be helpful. Finally, use of simple nonprescription saline nasal sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often beneficial.
The information provided above is for general use only, and medical decisions should not be made without consulting a physician. The information is provided by The American Academy of Otolaryngology Head & Neck Surgery Foundation.
