The Post Nasal Drip Blues

November 25, 2016 9:31 AM

YANMD. Every year without fail, by late fall/early winter, I develop post nasal drip. It quickly leads to a sore throat and then weeks of laryngitis. Prescription and OTC drugs aren't helping.

Once the post nasal drip (hereafter PND) turns into laryngitis, the laryngitis lasts for weeks. This is particularly tough on me as my job requires me to be on the phone for hours a day (email and non-phone work is not an option; I'm not seeking advice on how to cope with this at work- just advice on how to prevent or better treat the PND symptoms.)

I've seen my doctor about the PND several times, and after trying Nasonex and a few other nasal sprays and allergies meds, their advice is along the lines of 'shrug' or 'it is what it is'.

- Neti pots and other nasal irrigation tools, used sparingly, don't help me. It seems to provide about twenty minutes of relief and then we're back where we started, if not worse.

- Likewise, I haven't gotten much help from nasal sprays like Nasonex.

- When I see the first sign of PND, I start to avoid food and beverage that may worsen it. This includes anything that is acidic or a diuretic (coffee, tea, alcohol), high fat foods, dairy. It doesn't seem to lessen the symptoms but I'm assuming it prevents them from getting any worse.

- One year I used Zinc supplements to try to 'fight it off' and it seemed to keep it at bay, but then my friend pointed out that it clearly wasn't going away and I needed to just let it run its course. So I did and it was probably the worst sore throat I ever had.

- Lortadine (Claritin) is the med that has come closest to helping.

I am otherwise healthy (no sleep apnea, asthma, or other respiratory issues), get regular deep sleep seven hours a night, drink 2-4 liters of water a day depending on my activity level and sodium consumption, and get regular exercise. During the winter, I exercise indoors and not out in the cold. We have a dehumidifer at my current place that keeps it at 45-50% humidity. Any less than that and I get a dry cough. High humidity has been known to trigger my migraines.

Are there non-pharmaceutical solutions I could be using to prevent or better alleviate PND?
Other points I should be discussing with my doctor?
Reasons I may be prone to PND?
What has helped you with this?

posted by nightrecordings to Health & Fitness (16 answers total)

The Claritin helping is an interesting clue. Have you ever been tested for allergies? My post nasal drip is definitely allergy induced.
posted by joan_holloway at 9:38 AM on November 25, 2016 [2 favorites]

Have you been to an ENT? There may be treatment approaches that your primary care doctor is not aware of.
posted by ewok_academy at 9:43 AM on November 25, 2016

I was also going to suggest allergy testing. Dust allergies can affect you more in the fall/winter. I started allergy shots this summer and have spent so much less time sick this fall, it's amazing.
posted by arrmatie at 9:44 AM on November 25, 2016

Response by poster: @joah_holloway, @ewok_academy, @arrmatie: No official allergy test, and I've only seen an ENT once for a perforated eardrum, but past experience has made it abundantly clear I'm allergic to at least mold, if not dust. I don't deal well with ragweed/pollen in the spring, but that just gives me itchy eyes and a stuffy nose, as opposed to the postnasal drip I always develop around November and December. (I'm in Virginia, USA, if climate helps put this into context at all). I'll schedule an appointment now to see if my PCP can refer me to an ENT about this. The allergy shots sound promising?
posted by nightrecordings at 9:49 AM on November 25, 2016

Yes, ENT for allergy tests.

My guess is that you have inflamed tissue in your nose and/or sinuses, which becomes more troublesome at this time of year because this is the time we get less vitamin D which weakens the immune system. They may prescribe you anti-inflammatory nose drops to fight the inflammation, and strong anti-histamine nasal spray to stop it from re-inflaming whilst you are treating it. You may also get a prescription-strength vitamin D pill to get your immune system back in shape again (and that will help stave off the throat infections too).

Citation: I was in the same situation, got the above treatment, and went my first ever winter with no coughs, colds, or throat infections whatsoever. I'm not kidding. None, November through March. Life changer.
posted by greenish at 10:00 AM on November 25, 2016 [2 favorites]

My son has PND from very mild pollen and pet allergies. We found that OTC Zyrtec (Certizine) 10mg daily worked way better than Claritin for whatever reason. Maybe try that out for a few days?
posted by JoeZydeco at 10:24 AM on November 25, 2016 [1 favorite]

Sugar is also a big PND contributor. Do you by chance consume a lot of it?

Do you live in a climate that gets very dry and/or cold in the winter? A humidifier may also help you.
posted by Autumnheart at 10:41 AM on November 25, 2016

If Claritin helps, I'd expect Zyrtec to help more.
posted by actionstations at 11:08 AM on November 25, 2016

This sounds like it might be caused by an allergy to the leaf mold that's growing on all the rotting fallen leaves at this time of year.
posted by heatherlogan at 11:15 AM on November 25, 2016

Have you tried Sudafed, the real kind that you have to show your license to the pharmacist to get?
posted by dilettante at 11:25 AM on November 25, 2016

Hepa filter and change your actual pillow + put allergen cover on you mattress + launder and vacuum very often in winter!

Came in to suggest a humidifier for sleeping because holyfuckingshit for the past few years if I get a cold it is GUARANTEED bronchitis (inflammation) if I do not use a humidifier. Like something 2 weeks turns into 8 weeks of misery if I don't. *shudders*
posted by jbenben at 11:32 AM on November 25, 2016

Flonase is available over the counter now and I find it helps if you allergy symptoms are primarily nasal.
posted by tofu_crouton at 11:48 AM on November 25, 2016

My years long battle with post nasal drip turned out to be caused by food allergies. Mainly gluten, sugars, and nuts. Have you tried the Whole 30 diet? You might want to give that a shot just to rule out food triggers. If you're allergic to molds as well, you might want to also try the Mold Help Diet. I did them both at the same time and cleared up my post nasal drip completely. Over the next few months, I slowly incorporated the foods I missed most back into my diet to see which ones triggered the worse reactions and avoid those foods as much as possible, especially before bed. Try those before getting expensive allergy tests; you might be surprised.
posted by LuckySeven~ at 12:28 PM on November 25, 2016

The following used together can help make some headway: ClaritinD (the kind with pseudoephedrine that you have to get from the pharmacist's counter- it dries the drip), daily nasal irrigation with sinucleanse bulb, steroid nasal spray, low-carb diet, hypoallergenic bedding washed regularly with detergent and borax for maximum dust mite death, and hepafilter in the bedroom. Go see an ENT and allergist. Sounds like indoor allergies.
posted by quince at 4:07 PM on November 25, 2016

I have PND tied to a mould allergy. I've seen an ENT and an allergy specialist for it, and it was helpful, but ultimately there's not a tonne they can do other than suggest the sorts of things everyone here is already suggesting.

I manage it sufficiently that I no longer get throat infections. What works for me is: (1) daily Zyrtec when it's rotting leaf season; (2) using the NeilMed Sinus rinse twice a day; (3) HEPA filter in my bedroom, mattress cover and hypoallergenic pillows, generally embracing my neatfreak tendencies; (4) humidifier in the bedroom during the winter months, because our house is heated by forced air and gets incredibly dry.

I took nasal steroids (spray) for a while but I didn't notice any real improvement from using them over the stuff I was already doing.

Good luck!
posted by Severine at 4:18 PM on November 25, 2016

We have a dehumidifer at my current place that keeps it at 45-50% humidity. Any less than that and I get a dry cough. High humidity has been known to trigger my migraines.

45-50 is very high humidity for winter. If you keep your windows closed there is a good chance you are fueling mold growth somewhere.

I aim for 35% and struggle to get over 30% with two humidifiers and measuring right next to a humidifier in a tiny 1 bedroom apartment and I have asthma/PND/sinus trouble that is induced by dry air.

Humidity at night in the bedroom seems to more important to my well being than during the day where I can manually hydrate.

Getting a roomba also made a big difference as I was too lazy to vacuum enough manually to keep dust/dander under control.
posted by srboisvert at 4:33 PM on November 26, 2016