Postnasal drip

Disease Description (Causes and Symptoms)

• Definition: Chronic rhinosinusitis (CRS) is a condition in which inflammation of the mucous membranes of the sinuses (air-filled spaces in the facial bones beside the nose) and retention of secretions persist for 3 months or longer. Synonyms: chronic sinusitis, chronic rhinosinusitis.
• Pathophysiology (brief summary): Mucosal swelling and obstruction of the drainage pathways → retention of secretions → proliferation of bacteria/viruses and biofilms → persistent chronic inflammation. Allergies, anatomical narrowing (such as a deviated nasal septum), reduced immune function, smoking, and environmental factors can worsen the condition.
• Main symptoms: Nasal congestion (nasal obstruction), purulent rhinorrhea (purulent discharge), postnasal drip (secretions flowing down the back of the throat), facial pain or pressure, reduced sense of smell (hyposmia or anosmia), and general malaise (fatigue). Symptoms may be persistent or may follow a pattern of worsening and improvement.

Treatment Methods

• Basic principles: Combine symptom management (promoting secretion drainage and suppressing inflammation) with correction of causes (management of allergies, anatomical problems, and coexisting asthma).
• Conservative (medication) treatment
  • Saline nasal irrigation (normal saline) — a basic routine treatment that helps remove mucus.
  • Topical corticosteroids (spray-type nasal sprays or medications) — the cornerstone of suppressing chronic inflammation.
  • Oral steroids — used for a short period when polyps are present or symptoms worsen (under a doctor’s direction).
  • Antibiotics — used when there is an acute exacerbation or a bacterial infection is suspected (for persistent chronic infection, culture-based treatment is recommended).
  • Long-term low-dose macrolides (for anti-inflammatory effects) — selective use depending on guidelines and patient characteristics.
  • Treatment of coexisting allergies and asthma: antihistamines, immunotherapy (when an allergic mechanism is clear), and inhaled steroids (when asthma is also present).
• Procedures and surgery
  • Functional endoscopic sinus surgery (FESS): Considered when medication treatment fails, extensive polyps are present, recurrent purulent discharge occurs, or there is a risk of complications (orbital or intracranial involvement). The goals are to widen the drainage pathways and preserve the mucosa.
  • Correction of accompanying anatomical problems, such as polyp removal and septoplasty.
• Lifestyle management (self-care)
  • Stop smoking, maintain indoor humidity (avoid dryness), perform nasal irrigation frequently, avoid allergens (when there is an allergic cause), and drink sufficient fluids.
• Precautions and risk of complications
  • If left untreated for a long time, persistent loss of smell, recurrent infections, and ocular (orbital) or intracranial complications (such as orbital cellulitis, brain abscess, or meningitis) may occur — emergency evaluation is needed if severe facial pain, visual impairment, high fever, or altered consciousness develops.
  • Consider the side effects of steroid use (with long-term oral use) — including osteoporosis and increased blood glucose levels.
  • Recurrence is possible even after surgery, and the rate of repeat surgery increases, particularly in people with a deviated nasal septum, allergies, or asthma.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and information to prepare
  • A list of medications currently being taken (including prescriptions, OTC medications, and supplements) and the times they are taken
  • Copies of previous test results, if available (sinus CT, previous endoscopy findings, blood tests, culture results, etc.)
  • A record of when symptoms began and how they have progressed (when they started, whether they are persistent or intermittent, and aggravating factors)
  • A symptom diary (severity of nasal congestion, color and odor of nasal discharge, changes in sense of smell, fever, headache, etc.) — if possible, include photos (such as the color of nasal discharge) or a symptom scale
  • History of allergies (atopy, asthma, drug allergies, etc.) and smoking history
• Examples of questions to prepare in advance for the outpatient visit
  • Briefly summarize “when and how your symptoms have recently changed”
  • Whether you are taking any medications and how effective they are (especially nasal sprays, antibiotics, and steroids)

General Example Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (or nasal spray)?
• How likely is it that my symptoms can be controlled without surgery? What is the recurrence rate?
• What tests are recommended for my current symptoms (sinus CT, nasal endoscopy, allergy testing, culture testing, etc.)?
• Are there any lifestyle factors (smoking, indoor environment, etc.) that I must change?

Examples of Condition-Specific Questions

• Polyps were observed on nasal endoscopy or CT. If they do not improve with medication, when would you recommend surgery? What is the risk of recurrence after surgery?
• If asthma is also present, how does the treatment strategy change (especially regarding the use of inhaled steroids or biologic agents)?

(Note: The choice of diagnosis and treatment varies depending on the individual’s medical history, test results, and coexisting conditions, so the final decision should be made in consultation with the treating doctor.)