Endoscopic picture showing mucus draining from nose into throat.
Glands in the nose and throat normally produce 1-2 quarts of mucus every day. This mucus moistens the lining of the nose and sinuses, humidifies the air, traps inhaled particles, and helps to fight infections. Normally this mucus is swallowed unconsciously many times throughout the day. When the mucus becomes thick or excessive in volume, it can cause the sensation of post-nasal drip. Post-nasal drainage can often lead to cough, sore throat, frequent throat clearing, and the feeling of a lump in the throat.
An excess in thin, clear secretions can be from viral infections, allergies, spicy foods, temperature changes, pregnancy and some medications (birth control pills, blood pressure medications). Increased thick secretions can occur from low humidity in the winter, a decrease in fluid intake (dehydration), bacterial sinus infections, or from some medications (antihistamines). Swallowing problems or acid reflux can give patients similar symptoms of nasal/throat drainage or phlegm.
A correct diagnosis of the underlying problem is essential to properly treat a patient with post-nasal drip. Treatments for viral infections, allergies, and sinusitis are discussed in other sections. Acid reflux is treated with over-the-counter or prescription medications, depending upon the severity of the symptoms. Other causes are less common and should be thoroughly evaluated by an ENT specialist.
What is LPR?
LPR is similar to Gastroesophageal Reflux Disease, or GERD. It occurs when the lower esophageal sphincter (LED) does not close properly and the stomach contents are allowed to leak back or reflux into the esophagus and then up to the voice box and possibly the back of the nose and sinus cavity. When the refluxed stomach acid comes into contact with the lining of the esophagus, it causes a burning sensation in the chest or in the throat that we call heartburn or acid indigestion. When stomach contents irritate the voice box and back of the throat/nose, symptoms are less often heartburn and more often consist of post nasal drip, throat clearing, cough and lump in the throat.
What causes LPR?
Eating habits, diet, and obesity all contribute to the development of GERD. Eating large meals and lying down after eating may induce reflux symptoms. Many foods are acidic or contain irritating substances that increase the stomach’s production of acid. Obesity and pregnancy also contribute to LPR/GERD symptoms because the additional weight places increased pressure on the sphincter muscles in attempt to keep food in the stomach. Tight fitting clothing may place pressure inside the abdominal cavity much like excessive body weight does and therefore may cause reflux symptoms.
What are the symptoms of LPR/GERD?
The classic symptom of GERD is heartburn. Many people have LPR without any associated heartburn and instead they experience chest pain, hoarseness, difficulty swallowing, excessive mucous, throat clearing, a sensation of a lump in the throat, sore throat, choking spells, wheezing, post-nasal drip, dry cough, or bad breath.
What is the treatment for LPR/GERD?
Your doctor may also recommend medications that you can buy over the counter or may give you a prescription for a medication. These medications can help to neutralize the acid in your stomach, stop acid production, or help the muscles that empty your stomach. Medications work in different ways and a combination of medications may help to best control your symptoms. Your doctor is the best source of information on how to use these medications.
How do you diagnose LPR/GERD?
LPR/GERD may be diagnosed by carefully listening to the symptoms the patient reports along with a thorough examination of the head and neck. There are also a number of diagnostic tests available to help establish and monitor a diagnosis of LPR/GERD:
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