Question: I have had post nasal drip problems since May. Every doctor I go to tells me they don’t know what’s wrong and cannont find any relief. I’ve been prescribed Nasonex and Augmentin, but both made the problem worse. I have a sore throat, my tonsils hurt, and my post nasal drip is worsening. Even as I write this email, I’m hocking up mucous to spit out. It won’t stop… If you have any thoughts, please let me know. I will greatly appreciate it.
Answer: As you know, to really give you an accurate diagnosis would require your being seen and evaluated. However, we have found that many patients with continuos post nasal drip problems have a post nasal drip due to acid reflux. We call this “silent reflux” when stomach acid reaches the back of the throat and the nose, causing irritation and post nasal drip even if patients don’t have heart burn. The body then makes mucous in response. You can see more about it under sinus treatment on the nysinuscenter.com website. This can often be diagnosed on examination alone, but at times we recommend pH testing. This is a test in which a thin wire that measures acidity is placed into the back of the nose.
Treatment for silent reflux includes following an antireflux diet (not eating 3 hours before bedtime, limited caffeine, chocolate, alcohol, fatty foods, peppermint and a few others) and 6-12 weeks of antacid therapy (usually 2 OTC prilosec or prevacid 30-60 minutes before breakfast)- Sometimes evaluation of the esophagus is needed to make sure there are no more worrisome problems in patients with silent reflux.
Other evaluations I would suggest, if not done, include nasal endoscopy, culturing any nasal discharge and perhaps imaging the sinuses by CT scan to make sure there is not a persistent sinus infection or other such cause of your symptoms.
If you’re in the NY area, please make an appointment, and I think we should be able to help. If not, please see an ENT doctor who specializes in sinus problems near home and ask about the above possibilties..
R Pincus MD
Associate Professor Otolaryngology
NY Sinus Center
Frequently Asked Questions
One less obvious cause of continuous post nasal drip is acid reflux, also known as silent reflux. This occurs when stomach acid reaches the back of the throat and nose, causing irritation and increased mucous production even without classic heartburn symptoms.
Silent reflux can often be diagnosed through physical examination alone, but sometimes pH testing is recommended. This involves placing a thin wire into the back of the nose to measure acidity levels and confirm the presence of acid reflux.
Treatment typically includes following an antireflux diet that avoids eating before bedtime and limits caffeine, chocolate, alcohol, fatty foods, and peppermint. Additionally, 6 to 12 weeks of antacid therapy, such as taking OTC medications like Prilosec or Prevacid before breakfast, is recommended to reduce acid production.
If first-line treatments fail or the diagnosis is uncertain, additional evaluations such as nasal endoscopy, culturing nasal discharge, and sinus CT scans should be considered. These help rule out persistent infections or other sinus-related causes of post nasal drip.
Lifestyle changes include avoiding eating within three hours of bedtime, reducing intake of caffeine, chocolate, alcohol, fatty foods, and peppermint, all of which can trigger acid reflux and worsen post nasal drip symptoms.
Yes, if over-the-counter treatments and initial medical advice do not alleviate symptoms, seeing an ENT specialist who focuses on sinus problems is recommended. Specialists can perform detailed evaluations and provide more targeted treatments.
