What Is the Connection Between Post Nasal Drip and Cough?

Postnasal drip syndrome (PNDS) refers to the backflow of nasal inflammatory secretions from patients with rhinitis and sinusitis, which flows into the nasopharynx, oropharynx, and hypopharynx through the nostril, irritating the mucous membrane of the pharynx and causing discomfort in the pharynx. Is one of the important causes of chronic cough. In 2006, the American College of Chest Physicians recently published a clinical application guideline for cough, suggesting that the new term "upper airway cough syndrome" be used instead of the postnasal drip syndrome.

Basic Information

nickname: Upper airway cough syndrome
English name: postnasal drip syndrome
Visiting department: ENT

Common causes: Nasal inflammatory discharge
Common symptoms: Paroxysmal or persistent cough, mainly daytime cough, oral mucus attachment, itching of the throat, foreign body sensation, or "sticky throat" sensation, etc.

Causes of postnasal drip syndrome

Postnasal drip syndrome is the most common cause of chronic cough in adults and the second most common cause of chronic cough in children. The nasal mucosal cilia system is responsible for important defense functions. The cilia of the cilia are regularly swinged to transport the surface mucus to the nasopharynx to remove foreign pathogenic microorganisms and other particulate matter. When inflammatory diseases occur in the nasal cavity and sinuses, it stimulates the cough receptors distributed in the nose, sinuses, throat, etc., increasing the sensitivity of cough reflex. When postnasal drip, the cilia of the nasal mucosa is impaired, secretions from the upper respiratory tract increase, and drip back into the throat or lower respiratory tract, which stimulates the cough receptors here, creating impulses and coughing through nerve reflexes. Postnasal drip can also cause chronic inflammation of the posterior pharyngeal wall, hyperplasia of submucosal lymphoid follicles, and increase the inflammatory response of the lower respiratory tract and reflex bronchoconstriction.

Clinical manifestations of postnasal drip syndrome

Typical clinical manifestations are:

1. Paroxysmal or persistent cough, mainly during the day, and less coughing after falling asleep.

2. Most patients are accompanied by nasal endocrine reflux, oral mucus adhesion, itching of the throat, foreign body sensation, or "sticky throat" sensation, and frequent throat cleaning, that is, pharyngeal discomfort caused by nasal reflux Naturally, people will have a reflexive cough.

3. Patients with allergic rhinitis have itchy nose, stuffy nose, runny nose, and sneezing.

4. Some patients will still hoarse, and even speaking can induce cough.

5. Have a history of rhinitis, sinusitis, nasal polyps or chronic sore throat.

Postnasal drip syndrome

Nasal examination

Swelling of the mucous membrane can cause narrowing of the nasal cavity, secretions of different properties in the nasal passages, and drainage to the nasopharynx, or although there is no obvious abnormal nasal manifestation, obvious inflammation reactions, tumors and viscous secretions can be seen in the nasopharynx ;

2. Nasopharyngeal endoscopy

Visible redness, swelling and congestion of mucous membranes, mucus attachment, and redness and swelling in the pharynx;

3. Oropharyngeal examination

It can be seen that mucus or mucopurulent secretions draining down from the nasopharynx show chronic inflammation, lymphoid follicle hyperplasia, tonsil hypertrophy, and chronic inflammation changes in the mucosa through the region;

4. X-ray or CT scan of the sinuses

Chronic sinusitis manifestations were found, such as thickened nasal mucosa, blurred nasal cavity, and mucus in the sinuses.

Diagnosis of postnasal drip syndrome

For PNDS, there is currently no unified diagnostic standard in the otolaryngology community. Many scholars make judgments of postnasal drip based only on the patient's main complaint, symptoms, and nasal and nasopharyngoscopy findings. Has a paroxysmal or persistent cough; Has a history of rhinitis, sinusitis, chronic pharyngitis; Postnasal drip sensation, foreign body pharyngeal sensation, and mucous adhesion of the posterior pharyngeal wall, often requiring throat clearance, which can be accompanied by nasal congestion and runny nose And pharyngeal itching; examination showed follicular hyperplasia in the posterior pharyngeal wall, cobblestone-like view; X-ray of the sinuses or CT of the sinuses showed that the sinus mucosa was thickened, and the sinus cavity was ambiguous or had a liquid surface.

Treatment of postnasal drip syndrome

It is mainly for the treatment of various causes of PNDS.

1. Acute nasal cavity and sinus inflammatory disease treatment principles are anti-infection, improve nasal congestion, open the sinus opening, promote drainage and reduce inflammation. The main treatment of acute sinusitis is the application of antibacterial drugs. When the effect is not good or the secretions are large, nasal inhalation of glucocorticoids and decongestants can be used to reduce inflammation.

2. The treatment of chronic sinusitis can generally adopt the following initial treatment plan: apply antibacterial drugs effective for Gram-positive bacteria, Gram-negative bacteria and anaerobic bacteria for 3 weeks; nasal decongestants for 1 week; nasal inhaled glucocorticoid 3 months.

3. Postnasal drip syndrome caused by allergic rhinitis is effective with various antihistamines, and the second-generation antihistamines without sedation are preferred. Nasal inhaled glucocorticoids are also the drug of choice for allergic rhinitis. Improving the environment and avoiding allergen stimulation are effective measures to control allergic rhinitis. Allergen immunotherapy may be effective, but the onset time is longer.

4. Sinusitis is ineffective in conservative treatment and functional nasal endoscopy can be performed in patients with nasal polyps to remove the lesions and promote the recovery of physiological functions of the affected mucosa by reconstructing the ventilation and drainage of the nasal cavity and sinuses.

5. Chinese medicine treatment.

Prevention of postnasal drip syndrome

Prevention and treatment of postnasal drip syndrome should start from the prevention of rhinitis and sinusitis at the source. If you have acute inflammation, treat it promptly and do not make it chronic. If some children have chronic rhinitis, sinusitis and other symptoms such as runny nose, nasal congestion, sneeze, etc., they should be paid special attention by parents.