Postnasal Drip Syndrome (PNDS) Postnasal Drip Syndrome has a high incidence in children under 10 years of age, and people with allergies or chronic rhinitis, sinusitis, or nasal polyps are more likely to suffer from the syndrome, especially when the weather changes and the symptoms are more pronounced and severe. The prevention and treatment of postnasal drip syndrome should start with the prevention of rhinitis and sinusitis at the source. If acute inflammation develops, treat it promptly and do not let it become chronic. If children have to cough every morning, take a lot of antibiotics but the effect is not obvious, or have chronic rhinitis and sinusitis symptoms such as perennial runny nose, nasal congestion and sneezing, it is especially important to draw the attention of parents to seek timely medical consultation, make a clear diagnosis and take treatment measures as early as possible.
What is postnasal drip syndrome?
Postnasal drip syndrome refers to the backflow of nasal secretions through the posterior nostril into the nasopharynx and hypopharynx, and the resulting inflammatory reaction and recurrent coughing caused by the stimulation. “In otolaryngology clinics, it is common to see these patients with a lot of nasal discharge hanging in the posterior pharyngeal wall like a hanging waterfall, with lymphatic follicular hyperplasia and even cobblestone-like changes.” Patients with chronic, long-term recurrent cough should consider the possibility of postnasal drip syndrome, especially if they have a significant cough in the morning. This is because postnasal secretions flow into the throat at night and are discharged through coughing in the morning. Other patients often feel itchy and uncomfortable in the throat, with glue-like stuff sticking to the back of the nasopharynx, and snot often needs to be sucked backwards into the mouth to be discharged. These patients are also more prone to recurrent respiratory tract infections due to long-term secretion irritation.
Diagnosis of PNDS: (1) Episodic or persistent cough, predominantly daytime cough, less often after sleep (2) Postnasal drip or (and) feeling of mucus adherence to the posterior pharyngeal wall (3) History of rhinitis, sinusitis, nasal polyps or chronic pharyngitis (4) Examination reveals mucus adherence to the posterior pharyngeal wall, cobblestone-like view (5) Relief of cough after targeted treatment Treatment of PNDS: For suspected PNDS Patients should be treated specifically based on their possible underlying disease. For PNDS caused by the common cold, non-allergic rhinitis, vasodilatory rhinitis, and year-round rhinitis, 1st generation antihistamines (e.g., chlorpheniramine maleate) and decongestants (pseudoephedrine hydrochloride) are preferred. Most patients develop efficacy within a few days to 2 weeks after initial treatment. PNDS caused by allergic rhinitis is effective with a variety of antihistamines. 2nd generation antihistamines without sedative effects are preferred, commonly used drugs such as loratadine or asmizole. Nasal inhalation of glucocorticoids is the drug of choice for allergic rhinitis. The inhalation dose is usually beclomethasone propionate 50 μg/time/nostril or equivalent dose of other inhaled glucocorticoids once or twice a day. Sodium cromoglycate inhalation is also good for the prevention of allergic rhinitis and is applied at a dose of 20 mg/dose 3-4 times a day. Improving the environment and avoiding allergenic stimuli are effective measures to control allergic rhinitis. Allergen immunotherapy may be effective but has a long onset of action.
The main treatment for acute bacterial sinusitis is the application of antibacterial drugs, and nasal inhalation of glucocorticoids and decongestants may be used to reduce inflammation when the effect is poor or the secretion is high. For the treatment of chronic sinusitis, the guidelines recommend the following primary treatment regimen: application of antimicrobial drugs effective against gram-positive, gram-negative, and anaerobic bacteria for 3 weeks; oral 1st generation antihistamines and decongestants for 3 weeks; nasal decongestants for 1 week; and nasal inhaled glucocorticoids for 3 months. Negative pressure drainage, puncture drainage or surgery is feasible when internal treatment is not effective.
It should be noted in the treatment of PNDS that not all antihistamines have the same efficacy. Current research suggests that 1st generation antihistamines and decongestants are the most effective treatment options for most patients with PNDS. For PNDS caused by non-allergic causes that are not histamine mediated, treatment with 2nd generation antihistamines is likely to be ineffective.
Combined with my personal clinical experience and analysis of the efficacy achieved in the treatment of this disease, the prevention and treatment of this disease or the combination of Chinese and Western medicine is effective, but it is necessary to adhere to a period of conditioning.