Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Constant Post-Nasal Drip

Monday, 22 June 2009 03:53 PM

Question: I am a 65-year-old woman, and I have post-nasal drip almost constantly. An ENT physician ordered an X-ray and scope of my sinuses and ordered antihistamines and steroid sprays. I did the sinus rinses for many weeks, all to no avail. After researching on the Internet, I found articles about vasomotor rhinitis. I asked the ENT if this is what I have, and he said "yes" and that it's a nerve problem connected to getting older. Do you know of anything that I can do to alleviate this problem?

Dr. Hibberd's Answer:

Vasomotor rhinitis is a condition in which oversensitive blood vessels in the nasal lining dilate and cause runny nasal symptoms. (This is controlled by the autonomic nervous system — the unconscious system that regulates organ and circulatory function.) Causes can be weather changes, temperature variations, emotions, sleep deprivation, stress, chemical irritants, perfumes, aerosol sprays, and pollution.

Vasomotor rhinitis is simple to recognize, and your family doctor is well-suited to treat it. Testing is not necessary to diagnose this condition. Scope procedures and imaging are used for situations in which complete obstruction from a tumor or recurrent or persistent infection is suspected.

Most patients with vasomotor nasal symptoms need simple topical treatment. Ipratropium bromide nasal spray will dry up the excessive runny nose that intermittent nasal saline spray doesn't remedy. Some patients have coexisting allergic stimuli and will benefit from nasal corticosteroid sprays, as well as selective use of oral agents such as a rapidly acting antihistamine (Zyrtec, for example) with or without a prescription leukotiene blocker such as Singulair. The topical antihistamine spray Astelin may be useful for some.

Pseudoephedrine is available from a pharmacist without prescription to help control periodic, severe symptoms. In my experience, phenylephrine products (Neo-Synephrine) available from the pharmacy shelf are slightly less effective than pseudoephedrine. Both of these products can make symptoms worse if used too much. People with underlying disease such as diabetes, hypertension, or severe vascular/heart disease should use them with caution if at all.

Avoid using decongestant nasal sprays, such as Afrin, continuously for more than three to five days because they can make congestion worse and commonly require topical nasal steroids to resolve.

I am at a loss as to why saline sinus rinses were recommended for long-term use. Though some may benefit temporarily, I am not convinced that the risk/benefit of long term sinus rinsing is worthwhile in most patients. The sinus cavities are normally free of bacteria and inflammation, and repeated rinsing risks exposing you to increased incidence of infections.

Although treatment of vasomotor rhinitis is often trial and error, surgical options are rarely, if ever, necessary. Ninety-five percent of patients with vasomotor rhinitis will consult family physicians and allergists. ENT surgical consultation is available for those few who also require correction of underlying obstructions.

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