EpistemisPostnasal drip
Specialty: Otolaryngology.
Why it occurs
- Perennial allergic rhinitis due to sensitization to dust mites, animal epithelium or molds
- Chronic rhinosinusitis with or without nasal polyps that generates constant mucosal hypersecretion
- Non-allergic rhinitis (vasomotor or senile rhinitis due to hyperactivity of parasympathetic tone)
- Laryngopharyngeal reflux disease that stimulates the production of protective mucus by the pharyngeal submucosal glands
Initial workup
Nasofibrolaryngoscopy to evaluate the state of the nasal mucosa, meatus, cavum and posterior larynx, skin allergy tests (prick test) or determination of serum specific IgE, and CT of the paranasal sinuses if symptoms persist after appropriate medical therapy.
red flags
Presence of persistent expectoration with streaks of blood, progressive dysphagia, hard cervical adenopathy adhered to deep planes, unintentional weight loss, severe unilateral pain in the throat radiating to the ear, or obvious asymmetry of the tonsil or pharynx on examination.
Standard management
- Topical nasal corticosteroids such as fluticasone furoate — 2 sprays in each nostril every 24 hours for a minimum of 3 months
- Nasal antihistamines such as azelastine — 1 spray per nostril every 12 hours, very useful in mixed or vasomotor rhinitis
- Nasal ipratropium bromide 0.03% — 2 sprays per nostril every 8 hours if clear watery rhinorrhea predominates
- Nasal washes with warm isotonic saline solution before the application of drugs.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4