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What is the cause and treatment for post nasal drip?

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ENT Specialist
Practicing since : 2001
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Question

I am suffering from Post Nasal drip for the last about 15-20 year.Some times my problem aggravates.My problem has been aggravated for the last about two months back and Post nasal drip is taking place on the right side on my head and thick mucus is dripping down to my right ear and throat. There is heaviness in my head due to this.
I had visited an ENT specialist,who got my CT Scan done which showed that a soft tissue density polyp measuring 16 mmx16mm in the inferior wall of right maxilliary sinus and also mild deviated nasal septum.
He had also got my IgE level test done which was 443 IU/ML.
He diagnosed Allergy sinusitis and prescribed me Taxim OZ anti biotic and Mondeslor anti allergy medicine .Besides this he also prescribed Ezicas-F nasal spray and Rhinoset decongestant nasal spray.However,I have not got any relief .During my second visit he told me that there was no need for any surgery of my sinus polyp and deviated nasal septum and said that Post nasal drip is taking place due to allergy.
.He prescribed me Ezicas-F nasal spray and Romilast 10 tablet and also steam inhalation,But I have not got any relief so far.
Kindly suggest me effective treatment for my problem.Also let me know whether allergy is the root cause of my Post nasal drip. I have become hopeless. Is there any effective treatment for relief from allergy.
Posted Mon, 18 Aug 2014 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 1 hour later
Brief Answer:
Please see the answer below...

Detailed Answer:
Hi

Thanks for posting the query

I have gone through the history thoroughly and understood your problem. I'll try my best to help you out with this.

1. The post nasal drip is because of sinus block. Sinus block is secondary to the septal deviation. Associated allergy will worsen all of your problems.

2. At present, you need to continue with the steroid nasal spray and steam inhalation. Drink plenty of warm water.

3. If the discharge is yellowish or greenish you will require antibiotics such as a combination of amoxycillin & clavulanic acid or cefuroxime.

4. A mucolytic such as ambroxol to lighten the secretions.

5. Saline nasal spray to clear the secretions and keep the nose moist.

6. If the secretions are whitish in colour then you need to take a short course of oral steroids.

7. Avoid those things which induce allergy such as, dust, smoke, perfumes, pets, etc.

I am sure, with these above medications and preventive measures you will definitely do well.

Revert back to me if you have any further queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 10 hours later
I am presently also taking Medler tablet.Should I continue with this medicine.
Some days back I had taken predinisol 20 oral streoid for three days without any effect after which I discontinued the same.
Kindly also let me know the name of the company of which Ambroxol recommended by you to be taken .Is it in the form of syrup or tablet.Kindly also let me know the dosage of Ambroxol to be taken.
Is Jal Neti effective in my case.
 
 
Answered by Dr. Naveen Kumar 1 hour later
Brief Answer:
Medler is not required...

Detailed Answer:
Hi

Thanks for writing back

1. 3 days course of oral steroids are ineffective. You should take it for at least a week. Along with that, Steroid nasal spray is a must.

2. Medler is not required, it is beneficial in stuffy and running nose.

3. I usually prefer Mucosolvan, which is available both in tablet and syrup form. 1 tablet 3 times a day for at least 7 days is recommended. Alternatively, you can use Ambolar syrup.Your doctor will know about this.

4. Continue with steroid nasal spray, it will start acting on the tissues only after 2 weeks from the day you start using it.

5. Netipot is one of the best way to clear the nasal secretions and open the sinuses. I honestly, recommend you to use it

Hope this clears your doubts. Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 53 minutes later
Is oral streoid must for me.Is only nasal steroid spray not sufficient for me.
Should I take Romilast 10 as prescribed by my ENT doctor.
 
 
Answered by Dr. Naveen Kumar 4 hours later
Brief Answer:
You will require oral steroids...

Detailed Answer:
Hi

Welcome back

You will definitely require oral steroids. This will reduce the nasal congestion, edema and allergy. It will also help in reducing the size of the polyp.

Secondly, Romilast may not be of much help. But, there is no harm in taking the medicine.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 41 hours later
I have started oral steroid and other medications .In how many days I may get complete relief from my problem.
Can oral steroids be taken for more than a week and for how many days?
What are the side effects and what should be done to avoid the same.
I am feeling gas in my stomach and nausea.Is it due to oral steroids.
 
 
Answered by Dr. Naveen Kumar 3 hours later
Brief Answer:
Please see the answer below

Detailed Answer:
Hi

Thanks for writing back

1. Oral steroids should be taken for at least 10 days.

2. It should always be taken along with proton pump inhibitors. Or else, the individual will develop acidity. I wonder, why your doctor did not prescribe proton pump inhibitors along with this.

3. The most common side effect is acidity. There are no major side effects associated when used for short term.

Now you have already developed acidity, try taking omeprazole and domperidone till you finish your oral steroids. Avoid coffee/tea, smoking, spicy food and fizzy drinks, when you or on steroids.

Finally, the dose of the steroids need to be gently tapered before stopping it, or else, one may experience withdrawal effects.

Hope this clears your doubts.

Regards
Dr. Naveen Kumar
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 4 days later
I have completed the oral steroid predinisol 20 course of one week.please tell me Now what should I do.I am continue to use medications suggested by you.However,I have not got any relief so far.Infact during the last two days the post nasal drip and mucous production have increased.
Please let me know whether weather had any effect on the increase in the post nasal drip.
I continue to use steroid nasal spray.Please also let me know in how many days the steroid nasal spray with show its full benefits and ease the symptoms.
My ENT doctor has told me that the since there is only mild deviated septum,there is no need for any septal surgery.Please let me know whether there is any need for surgery of my deviated septum.
Can sinus polyp increases mucous production?

 
 
Answered by Dr. Naveen Kumar 1 hour later
Brief Answer:
Please see the answer below...

Detailed Answer:
Hi

Welcome back

Oral Prednisolone should not be stopped abruptly; it has to be gently tapered and then stopped. If stopped abruptly, all the symptoms will revert back. Your ENT surgeon will know about tapering it.

Secondly, if you could post the images of CT scan, I can comment about the status of the sinuses and the septum.

When polyp is present, the discharge will be definitely seen.

Also, could you please let me know, whether you are taking oral mucolytic and using saline nasal spray along with steroid nasal spray.

Environment and climate, definitely plays a role in nasal allergy. Change in climate can either worsen or relieve the symptoms.

Awaiting for your reply....

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 1 hour later
I have uploaded the image of NCCT of paranasal sinuses(Coronal section) along with its report.Please see them
I am taking the oral mucolytic and using saline nasal spray along with steroid nasal spray as suggested by you.
Kindly also let me know whether there is any need for surgery of my right maxilliary sinus.My ENT doctor has told me that there was no need of any surgery of polyp.
I continue to use steroid nasal spray.Please also let me know in how many days the steroid nasal spray with show its full benefits and ease the symptoms.
It may be mentioned that I am feeling post nasal drip on the right side of my head only.What could be the reason for this.
 
 
Answered by Dr. Naveen Kumar 51 minutes later
Brief Answer:
Please see the answer below...

Detailed Answer:
Hi

Thanks for uploading the images. Now, I have a complete idea about your problem.
1. There is a small polyp in the right maxillary sinus, but the opening of both maxillary sinuses are patent.
2. On both the sides, the inferior turbinate is hypertrophied. This causes narrowing of the nasal passages.
3. Septum is deviated to the right along with a spur, thus causing further narrowing of the nasal passage on the right. Hence, the secretions are retained for a longer duration on the right compared to that of the left. The retained secretions trickle down slowly into the throat giving the feeling of post nasal drip.
4. Hypertrophied turbinates are indication of nasal allergy.
5. You need to use the steroid nasal spray for atleast 3 months. By that time, the turbinates may shrink.
6. If your symptoms do not improve within 2-3 months, I would suggest you get septoplasty done, along with turbinoplasty (reduction of the turbinates).
7. Please continue with the rest of the medicines as advised.

Hope this clarifies your doubts.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 37 minutes later
Can I go for septoplasty and turbinoplasty immediately as I am facing lot of heaviness in the head due to accumulation of secretions on the right side of my head which had impaired my day to day working . I can not wait for two-three months.Is there any harm in getting the septoplasty and turbinoplasty done immediately.
 
 
Answered by Dr. Naveen Kumar 27 minutes later
Brief Answer:
You can get it done at any point of time...

Detailed Answer:
Hi

Welcome back

You can get the surgery done at any point of time. But, we need to try with medicines first. If it's not improving with medicines for a certain period of time, then, surgery will be the only option.

There is no harm in getting septoplasty and turbinoplasty done in the same sitting.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for post nasal drip? 22 hours later
1.My ENT doctor has prescribed Fluramist-AZ nasal spray( Fluticasone Furoate and Azelastine hydrochloride) for me along with Romilast FX .I am presently using Efnase(Fluticasone Propionate) for the last one and half week.Please tell me if I should discontinue Efnase.

2.Please also tell me whether I should take Romilast FX.

3.Please remove my doubts about the use of oral steroid. Please let me know whether other anti allergy medicines are become ineffective after the use of oral steroid.Some one has told me that after using oral steroid ,the anti-allergy medicines stops working.
 
 
Answered by Dr. Naveen Kumar 5 hours later
Brief Answer:
Please see the answer below...

Detailed Answer:
Hi

Welcome back

1. When you are using Fluramist AZ, then, Efnase is not required, as, both are the same drugs.

2. Please don't use Romilast FX at present as it will increase the consistency of the secretions and worsens your present problem.

3. When steroid is taken with antihistamine, the efficacy of the latter doesn't decrease. Instead, steroid augments the potency of antihistamine.

4. To summarise, please follow the below mentioned:
- Fluramist AZ
- Mucolytic
- Saline nasal spray
- Oral steroids ( only, if your doctor advises)
- Steam inhalation
- Avoid coffee

Hope this clears your doubts.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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