Post-Nasal Drip (Catarrh)
Post-nasal drip is one of the commonest throat and nose symptoms I see in adult ENT practice. Patients usually describe a constant feeling of mucus at the back of the nose or throat, repeated throat clearing, the need to keep swallowing, a cough, or the sense that something is always “there” even when they cannot actually clear very much. The term catarrh is often used in the same way.
I see many patients with this problem. It can be persistent, frustrating, and difficult to describe. One of the most important things to understand is that post-nasal drip does not always have to come from the nose. In some patients there really is excess mucus coming from the nose or sinuses. In others, the main problem is throat irritation, reflux, dryness, or increased sensitivity in the throat, which creates the feeling of mucus even when there is not a large amount of true nasal drainage.
What do patients usually mean by post-nasal drip?
Patients often describe:
mucus dripping down the back of the throat
frequent throat clearing
repeated swallowing
a need to cough to clear the throat
a feeling of a lump or something stuck in the throat
a sore or irritated throat
a croaky voice or intermittent hoarseness
worse symptoms first thing in the morning or when lying down
The pattern matters. True nasal mucus tends to come with other nasal symptoms such as blockage, sneezing, sinus symptoms, or runny nose. A mainly throat-based pattern may suggest reflux, dryness, or laryngeal sensitivity instead.
Post-nasal drip does not always come from the nose
This is one of the most important things for patients to understand. The sensation of mucus in the throat is real, but the source is not always the nose or sinuses.
Some patients do have genuine mucus running from the back of the nose into the throat because of rhinitis or sinus disease. But in others, the main problem is irritation or sensitivity in the throat itself. Reflux, repeated throat clearing, chronic cough, or a sensitive upper airway can all create the feeling of mucus even when there is not a large amount of true nasal drainage.
That is why some patients are treated for “sinus” or “allergy” problems for a long time without really improving. The symptom may feel nasal, but the main driver may actually be in the throat.
What can cause post-nasal drip?
There is no single cause. Common possibilities include the following.
Rhinitis
Rhinitis means inflammation and swelling of the lining of the nose. It may be allergic, non-allergic, or mixed. This is one of the commonest causes of true post-nasal drip. Patients often also notice sneezing, itching, runny nose, fluctuating blockage, or symptoms triggered by pollen, dust, perfumes, weather changes, or irritants.
Sinusitis or chronic sinus inflammation
Inflammation in the nose and sinuses can lead to persistent mucus drainage, facial pressure, blockage, poor smell, and throat clearing. Nasal polyps can also contribute.
Laryngopharyngeal reflux
Silent reflux is a very common alternative explanation. Reflux can irritate the throat and voice box and cause throat clearing, cough, a lump sensation, hoarseness, and the feeling of excess mucus even without heartburn. This is one of the commonest reasons why patients feel they have post-nasal drip even when the nose is not the main problem.
Throat sensitivity or laryngeal hypersensitivity
Sometimes the nerves in the throat become too sensitive after an infection, irritation, reflux, or a long period of throat clearing. The result can be a constant awareness of mucus, a tickle, cough, or the urge to clear the throat even when there is no major structural problem.
Dryness and mouth breathing
A blocked nose can lead to mouth breathing, and that dries the throat. Dryness can make normal mucus feel thicker and more noticeable, which then drives more throat clearing and irritation.
Decongestant spray overuse
Some patients develop a cycle where the nose feels blocked, they use sprays more and more often, and the lining becomes more swollen and irritated over time. That can worsen both blockage and catarrh-type symptoms.
Other contributing factors
Smoking, irritants, poor hydration, medication effects, and wider inflammatory conditions can sometimes contribute as well. In many patients there is more than one cause at the same time.
How is it investigated?
The first step is a careful history. I want to know whether the problem feels mainly nasal, mainly throat-based, or mixed. I ask about blockage, sneezing, runny nose, facial pressure, smell loss, reflux symptoms, cough, throat clearing, hoarseness, dryness, medication use, and whether symptoms are worse after meals, overnight, or at certain times of year.
I then examine the nose, throat, and ears, and in most cases I perform a nasal endoscopy and, where needed, a flexible examination of the throat. This helps me assess rhinitis, sinus drainage, polyps, structural problems, and also whether the throat and voice box look irritated in a way that points more towards reflux or throat sensitivity.
Most post-nasal drip is caused by inflammation, reflux, or throat sensitivity rather than anything serious, but persistent one-sided symptoms, blood-stained discharge, or progressive symptoms should still be assessed properly.
Not everybody needs lots of tests. Depending on the history and examination, further investigations may include allergy testing, CT imaging of the sinuses, or occasionally reflux assessment. In some patients, the main value of the consultation is working out what the symptom is not and avoiding treatment aimed at the wrong cause.
What treatments help?
Treatment depends on the cause.
Treatment when it really is coming from the nose
If rhinitis or sinus inflammation is driving the problem, treatment may include saline rinses, nasal steroid sprays or drops, antihistamines, trigger avoidance where appropriate, and treatment of sinus disease. These treatments work best when used properly and consistently.
Treatment when the main problem is throat irritation or reflux
If the symptom is more throat-based, treatment may need to focus on reflux, hydration, reducing throat clearing, and sometimes speech and language therapy. In these patients, the aim is to calm the irritated upper airway rather than assuming the nose is the main problem.
Treating contributing factors
Dryness, mouth breathing, smoking, irritants, and decongestant spray overuse can all make the symptom worse. Post-nasal drip is often not one single diagnosis but a symptom with several contributors.
How I approach this in clinic
When I assess a patient with post-nasal drip, my aim is not simply to confirm that they feel mucus in the throat. The key question is whether the symptom is mainly coming from the nose, mainly coming from the throat, or being driven by a combination of both.
For some patients the main issue is allergic or non-allergic rhinitis. For others it is sinus inflammation. In many, though, the bigger factor is reflux, throat clearing, dryness, or throat sensitivity. I see many patients with this symptom, and getting the right diagnosis early often matters more than trying multiple treatments aimed at the wrong cause.
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.