Postnasal drip is an unscientific term that refers to the sensation of thick phlegm in the throat, which can become infected. It is annoying because normally the nasal secretions and throat mucous glands moisten the throat. This is part of the mucous - nasal cilia system that defends us from disease. When the amount of liquid secreted by the nose and sinus is reduced, and the cilia of the nose and sinus slow down, the fluid thickens and you become aware of its presence. Since the thick phlegm is unpleasant and often infected because it is just laying there and not moving, our bodies naturally try to get rid of it. Whether caused by pollution, chemical exposure, or severe infection, the treatment requires that the cilia mucous system be brought back to normal.

Before treatment is started, a diagnosis must be made to understand why you have post nasal drip that affects your sinus areas. This requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies.

• Bacterial infection is treated with antibiotics, but these drugs may provide only temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses or drainage pathways may be required.

• Allergy is managed by avoiding the cause where possible. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, various other forms of steroids, and hyposensitization (allergy shots) may be used. However, some antihistamines may dry and thicken secretions. Even more, decongestants can aggravate high blood pressure, heart, and thyroid disease (these drugs commonly are found in non-prescription medications for colds). Steroid sprays generally may be used safely for years under medical supervision. However, oral and injectable steroids, which rarely produce serious complications in short term use, must be monitored very carefully if used for prolonged periods because significant side effects can occur.

• Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding late evening meals and snacks and eliminating alcohol and caffeine. Antacids and drugs that block stomach acid production may be prescribed. A trial of treatment may be suggested before x-rays and other diagnostic studies are performed.

• Structural abnormalities may require surgical correction. A septal deviation can prevent normal drainage from the sinus area and contribute to the development of chronic sinusitis, with post nasal drip as one of its symptoms. A septal spur (sharp projection) can cause irritation and abnormal secretions. A septal perforation (hole) can cause crusting. Enlarged or deformed nasal turbinates (the structures on the side walls of the nasal cavity which regulate and humidify airflow) and/or polyps (i.e. outgrowths of nasal membrane resulting from infection, allergy or irritants) may cause similar problems.

It is not always possible to determine whether an existing structural abnormality is causing the post nasal drip or if some other condition is to blame. If medical treatment falls, the patient must then decide whether to undergo surgery in an attempt to relieve the problem.

Nasal irrigations may alleviate thickened or reduced nose and sinus secretions. These can be performed two to six times a day either with a nasal douche device equipped with a special nasal irrigation nozzle. Warm water with baking soda or salt (1/2 tsp. to the pint) may be helpful. Finally, use of simple saline non-prescription nasal sprays to moisten the nose is often very helpful.