Some people feel as if phlegm is always stuck in their throat and need to clear their throat several times every morning before it feels clear. If blowing your nose brings out very little, yet you keep feeling something running down the back of your throat, postnasal drip may be the cause.
The nose and sinuses normally produce a considerable amount of mucus every day, which naturally drains down the back of the throat. Most of the time we swallow it without noticing, but when the amount increases or it becomes thick, it is felt as a sensation of something stuck and as coughing. Below we go through the causes and how to manage it, step by step.
Summary
- Postnasal drip is less a disease name than a symptom produced by various causes such as rhinitis and sinusitis
- It is considered one of the common causes of chronic cough lasting 8 weeks or longer
- Treatment differs by cause, so the pattern of nasal discharge and accompanying symptoms need to be considered together
- Indoor humidity, fluid intake, and saline rinses help as basic care
- Blood-tinged discharge, symptoms that persist on only one side, and difficulty swallowing are signs that you need medical care
1. What is postnasal drip syndrome?
Postnasal drip refers to secretions flowing down the back of the nose into the throat (pharynx). The condition in which this causes a sensation of something in the throat, frequent throat clearing, coughing, and voice changes is called postnasal drip syndrome. More recently, the term upper airway cough syndrome is also used.
Common complaints include the following.
- A feeling of phlegm stuck in the throat and a habit of frequently clearing the throat
- A cough that gets worse when lying down, especially at night or early in the morning
- A scratchy throat or hoarse voice
- Bad breath and nausea
How strongly postnasal drip is felt is not determined by the amount of secretion alone. Mucus may become thick and hard to swallow, or the lining of the throat may become sensitive, so the same amount feels like more. That is why some people are bothered even when endoscopy shows little secretion, while others have quite a lot of secretion but few symptoms. When symptoms last a long time, the sensation can become a preoccupation and throat clearing can turn into a habit, which can create a vicious cycle by further irritating the throat.
2. Causes: why nasal discharge increases
| Cause | Characteristic clues |
|---|---|
| Allergic rhinitis | Clear runny nose, sneezing, itchy nose, changes with the season or dust |
| Non-allergic rhinitis | Clear runny nose increases with cold air, odors, or temperature changes |
| Acute or chronic sinusitis | Yellow or thick discharge, facial heaviness, reduced sense of smell |
| After a cold | Cough and postnasal drip can linger for weeks after the infection |
| Gastroesophageal reflux | Heartburn, sour regurgitation, and a sensation of something in the throat occur together |
Strictly speaking, gastroesophageal reflux does not increase nasal discharge, but it irritates the throat and creates a sensation very similar to postnasal drip. In practice, both can be present at the same time, making them hard to tell apart by symptoms alone. Dry indoor air, smoking, and some medications, such as certain blood pressure drugs, can also thicken secretions or irritate the throat.
3. What we check in the clinic
Even when symptoms are similar, postnasal drip has many possible causes, so finding the cause is important. In the clinic, we first ask about the color and amount of nasal discharge, when symptoms started, whether they are seasonal, and accompanying symptoms such as heartburn.
The following questions are especially helpful in narrowing down the cause: whether the nasal discharge is clear or yellow, whether sneezing and an itchy nose come with it, whether symptoms get worse in a particular season or place, whether the sensation in the throat increases after meals or when lying down, and whether you have recently had a cold. Jotting these down briefly before your appointment helps you share all the necessary information even if the consultation is short.
Next, we use nasal endoscopy to look directly at the back of the nose and the throat to check where the secretions are coming from, whether the lining is swollen, and whether there are nasal polyps. Depending on the situation, allergy testing or a sinus CT scan may be considered. If the cough has lasted 8 weeks or longer, a chest evaluation is sometimes done as well to rule out asthma or other lung conditions.
4. Treatment and daily care
The principle is to match treatment to the cause. If allergic rhinitis is the cause, nasal steroid sprays or antihistamines are considered; if bacterial sinusitis is suspected, antibiotics are considered. If gastroesophageal reflux is also present, dietary changes and acid-suppressing treatment are sometimes used together. It is safest to decide on the choice and duration of medication with a doctor.
Helpful measures in daily life include the following.
- Saline nasal rinses: Wash out thick secretions and keep the lining moist
- Keeping indoor humidity at 40–60%: Dry air makes secretions thicker
- Drinking enough fluids: Helps make secretions less thick
- Raising your head slightly in bed: Can reduce the feeling of secretions pooling when lying down
- Avoiding late-night snacks and heavy drinking: Especially important if reflux is also present
- Clearing your throat less: Repeated throat clearing irritates the throat lining further, so try swallowing a sip of water instead
5. Signs that you should see a doctor
In the following situations, do not dismiss it as simple postnasal drip; see an ENT specialist.
- Discharge is mixed with blood, or symptoms persist in only one side of the nose
- Swallowing is difficult or painful
- Hoarseness lasts 3 weeks or longer
- High fever or swelling of the face or around the eyes is also present
- Weight loss, shortness of breath, or blood when you cough
Frequently Asked Questions
Q. Is it better to spit out phlegm or swallow it? A. Normal nasal secretions are mostly handled by stomach acid when swallowed, so there is no need to worry much. However, repeatedly forcing it up to spit it out can irritate the throat further.
Q. Do I have to take medication if I have postnasal drip? A. If symptoms are mild, humidity control and nasal rinses alone sometimes help. If symptoms last several weeks or more or interfere with daily life, it is better to identify the cause before deciding on treatment.
Q. My cold is gone, but the cough and postnasal drip continue. A. It is not uncommon for a cough to linger for several weeks after a cold, and it usually fades gradually. If it lasts 8 weeks or longer or keeps getting worse, other causes need to be checked.
This article is general health information and is not a substitute for individual medical care. If symptoms persist or worsen, please seek treatment at a medical institution.