Post-nasal trip syndrome R09.8 ; J42

The Postnasal-Drip-Syndrome, short PNDS, is not an independent clinical picture, but a symptom that can be related to different basic diseases of the upper and lower respiratory tract.

Overproduction of secretion through the nasal mucous membrane or the mucous membranes of the paranasal sinuses, or a disturbance of the flow of secretion, leads to an accumulation of secretion in the throat area and to a chronic flow of secretion from the back of the nose to the back wall of the throat. Postnasal drip syndrome is one of the most common causes of chronic coughing. It is also known as upper airway cough syndrome.

The cause is often an allergic or non-allergic, viral or bacterial sinusitis or rhinosinusitis. The mucus caused by the sinusitis flows into the tracheobronchial system and causes acute bronchitis.

It is possible that age is one of the causes. The cilia of the mucous membrane slowly decrease with age. This also reduces the mucociliary clearing capacity of the mucous membrane. The tiny droplets of mucus that leave the glandular cells can no longer be sufficiently removed. They initially remain in place. The addition of further mucus droplets leads to their enlargement. The droplets of mucus become so large that they drip down along the mucosa.

Frequent clearing of the throat, mucus flowing down the throat into the bronchi, coughing with sputum, chesty cough, chest pain, headache and facial pain, stuffy nose, less often general feeling of illness.

The secretion that flows down the throat is produced in the nose and sinuses. The mucus road that forms during this process can be diagnosed by anterior rhinoscopy, nasal endoscopy and inspection of the throat.

Secretolytics, anti-inflammatory therapies (e.g. by nasal spray containing cortisone) as well as mucosal decongestants or anti-allergic preparations, antihistamines, antibiotics, leukotriene receptor antagonists, cough suppressants. Inhalation and rinsing of the paranasal sinuses with sage or chamomile concentrates. Supplementary rinses with 0.9% saline solution.

If the conservative treatment fails, a surgical procedure may be considered with the aim of opening the sinus ostia and thus restoring mucociliary function. By removing diseased tissue, the nasal obstruction is reduced and the endonasal application of topical medication is facilitated. Foreign bodies in the sinuses and bony anatomical variants leading to the obstruction can be removed. Opening the olfactory gap can also improve the sense of smell.

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