Nasal discharge, frequent throat clearing, and mucoid or mucopurulent secretions in the posterior pharynx suggest postnasal drip. This symptom typically results from infection or allergies—a thick, tenacious, and purulent discharge suggests infection, whereas a watery discharge usually suggests an allergy. Postnasal drip may also result from environmental irritants.
Ask the patient when his postnasal drip began and if it’s continuous or intermittent. Does it occur during a certain season? What relieves or aggravates it? Ask about related signs and symptoms, such as cough, sinus pain, headache, and nasal congestion. Take an allergy history, and ask about occupational exposure to environmental irritants (chemical fumes, dust).
If the patient has mucosal swelling, use a vasoconstricting nasal spray before beginning the nasal examination. Then use a nasal speculum to assess the mucous membranes, which are normally pink to dull red. Observe the size and shape of the turbinates and septum, noting any abnormal structures and characterizing the secretions. If the patient wears dentures, ask him to remove them before you examine his throat. Use a tongue blade to examine the oropharynx and a size-0 indirect mirror or fiber-optic nasopharyngoscope to examine the nasopharynx for drainage. Finally, palpate the sinus areas for swelling and tenderness. (See Palpating the sinuses, page 624.)
Two types of rhinitis—allergic and vasomotor—can produce postnasal drip. With allergic rhinitis, symptoms can occur seasonally, as with hay fever, or year-round, as with chronic rhinitis. Nasal obstruction and edematous, pale nasal mucosa may be apparent. The mucosal surface appears smooth and shiny, and the turbinates fill the air space and press against the nasal septum. The patient has swollen, red eyelids and conjunctivae and excessive tearing. He also develops paroxysmal sneezing, a thin nasal discharge, a diminished sense of smell, frontal or temporal headache, and eye, nose and, possibly, throat itching.
A recurrent postnasal drip occurs with vasomotor rhinitis, which can be aggravated by dry air or other environmental triggers. Related findings include engorged inferior turbinates, nasal obstruction, sneezing, watery or sticky rhinorrhea, a pink nasal septum, and bluish mucosa.
This disorder commonly produces postnasal drip. It may also cause headache, sinus pain, purulent rhinorrhea, halitosis, fever, sore throat, cough, malaise, and red, swollen nasal mucosa and turbinates.
Exposure to environmental irritants, such as fumes, smoke, or dust, may cause postnasal drip. Other findings depend on the type of irritant and the duration of exposure but may include a cough and itching or burning eyes, nose, and throat.
If sinus pain accompanies postnasal drip, apply wet hot packs to the sinuses and instruct the patient to avoid nasal irritants such as tobacco smoke. Prepare the patient for diagnostic tests, such as sinus
X-rays, computed tomography scan, and culture and sensitivity studies.
If a child has postnasal drip (less common in children than a runny nose), inspect his nose by pushing its tip upward to visualize the anterior nares. If the child is younger than age 5, use a pediatric fiber-optic nasopharyngoscope to examine the nasopharynx.
Remind the patient not to use an oral decongestant for longer than 1 month at a time. If he has hypertension, advise him to avoid systemic decongestants. Warn against overuse of nasal decongestant sprays, which can produce rebound rhinitis. If he has allergic rhinitis, recommend an antihistamine.
Read excerpts from these other book chapters related to Postnasal drip:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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