The Post-Nasal Drip Myth

One of the most common complaints I hear from patients in the office is, “Doctor, I have a post-nasal drip.” Or simply, “Hi, I got a drip.”

Posted on | Jonathan E. Aviv, MD, FACS

One of the most common complaints I hear from patients in the office is, “Doctor, I have a post-nasal drip.” Or simply, “Hi, I got a drip.”

Let’s first talk about the term post-nasal drip, one of the great misnomers in medicine. Why? Because we normally produce 1 liter (33.8 ounces or 4 cups or 1 quart or a quarter gallon) of mucus every day from our nose, sinuses and throat.  To announce, “I have a post-nasal drip” is like announcing, “I yawned this morning.” Congratulations.

The question is, what typically happens to this steady volume of mucus that is produced? Typically, it is swallowed. Yes, it is swallowed. We swallow about one thousand times per day. When we are not eating, we are swallowing our saliva. Mixed in there, in addition to saliva, is mucus from our nose, sinuses and throat. There are mucus glands that not only line the sinuses located around the nose, but in the nose itself and the entire throat that contribute to this volume of fluid. So why are we complaining about a drip? It is either because the mucus itself is too thick to travel where it is supposed to go or because of some obstruction to the normal flow of mucus. Lets analyze each situation.

  • Mucus too thick Infections can thicken mucus and often change its color from a normal white bubbly appearance to a yellow or green glob. Most commonly a sinus infection can present as thick, yellow/green mucus that is making its way out of the sinuses and into your throat. Also very common is a lung infection like bronchitis that causes thick yellow/green mucus to be coughed up from the lungs into the windpipe then into the throat. Another very common source of thickened mucus is medications, for example, antihistamines. The end result is the same. Thick phlegm marinating in your throat and you want to hock it up.
  • Obstruction to flow Swelling of the tissues in the throat can block the free passage of mucus. While infection of the throat can be a cause of such swelling, the most common cause of swelling in the throat is stomach acid coming up and over time burning the throat tissues. This is called acid reflux disease. The burn from the acid causes swelling and the swelling causes mucus to be hung up.

In either case, mucus too thick or mucus blocked, you should see your doctor for an exam of your nose, sinuses, throat and lungs. Often your doctor, by listening to your history of how you describe your mucus problem, and by examining your chest, can figure out the source of your mucus complaint. Sometimes, you will need an examination by an ear nose and throat  (ENT) specialist. As was recently shown on The Dr. Oz Show, the ENT doctor, again after taking a detailed history of your mucus complaint, can use an ultra-thin scope that has a camera on it, to look at the nose, sinuses and throat to detect the source of your problem.

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Blog written by Jonathan E. Aviv, MD, FACS
Author of over 60 scientific papers in peer-reviewed journals and Flexible Endoscopic Evaluation of Swallowing with Sensory...