Postnasal drip: causes and which doctor to see

For postnasal drip you can first see: Ear, Nose & Throat (ENT) or Family Medicine or Allergy & Immunology. In large hospitals, the Allergy and Immunology unit also deals with this. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: a feeling of mucus or phlegm running down the throat; frequent throat clearing and sniffing back; a cough that is worse when lying down at night and on getting up in the morning; a tickle, itch or mild soreness in the throat; hoarseness and bad breath; phlegm in the mouth and a feeling of nausea in the morning. Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: hay fever (house dust, pollen, pet hair); the recovery period after a cold or flu; acute or chronic sinusitis; cold, dry air, cigarette smoke and strong smells; reflux (stomach contents coming up to the throat); deviated septum, enlarged turbinates and nasal polyps; enlarged adenoids in children. Only a doctor’s examination can determine the exact cause.

Drip after a cold usually lessens in 1–3 weeks. Drip due to allergy is controlled by avoiding the allergen and using the treatment the doctor recommends. If there is an underlying cause such as sinusitis, a deviated septum or reflux, the drip only goes away when that problem is treated.

It is more common in: people with hay fever; people who often get sinusitis; smokers and people in smoky environments; people with a deviated septum or polyps; people with reflux.

The ENT specialist examines inside the nose and the back of the nose and, if needed, looks with a thin camera (endoscopy). If allergy is suspected, skin or blood allergy tests are requested; if chronic sinusitis is suspected, a sinus CT.

Avoiding allergens, regular nasal rinsing, stopping smoking and keeping the air at home humid reduce postnasal drip.

Yes. Mucus running into the throat triggers the cough reflex; the cough gets worse especially when lying down and on getting up in the morning. It is one of the most common causes of a cough lasting weeks.

With postnasal drip there is usually a blocked nose, sneezing or sinus symptoms. With reflux, heartburn, bitter-sour fluid coming up into the mouth and throat clearing that gets worse after meals are to the fore. Sometimes both are present.

If an underlying allergy, chronic sinusitis, deviated septum or reflux is not treated, the drip comes back. For cases lasting more than 3 weeks, an ENT examination is needed.

If the answer to any of these questions is yes, call 112 without delay: “With the drip, is there swelling around the eye, vision problems, or a severe headache and stiff neck?” “Is there bloody phlegm, shortness of breath or chest pain?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: postnasal drip and cough have lasted more than 3 weeks; the drip is thick yellow-green and bad-smelling, or comes with facial pain; there is one-sided or bloody discharge; there is heartburn and bitter fluid coming up into the mouth (to check for reflux).