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May 24, 2013
Dear Mayo Clinic:
I am an 85-year-old man who has had a postnasal drip problem since childhood. Years ago, after many tests, I was diagnosed with nonallergic rhinitis. I have tried pills and sprays to help the symptoms, but nothing works very well. I feel as though I'm constantly blowing my nose and often clearing my throat. Do you have any suggestions that will allow me to go more than an hour with some relief?
The problems of a chronic runny nose and postnasal drip — excess nasal drainage that runs down the back of your throat — can be challenging to effectively manage. Although they may not seem to be major medical problems, these symptoms can have a big impact on a person's quality of life. Successful treatment often depends on identifying their underlying cause.
Even though your symptoms have appeared to be the same for many years, it is possible that the source of those symptoms actually may have changed over time. The potential causes of a chronic runny nose and postnasal drainage can vary as people age.
In younger people, for example, a chronic runny nose along with other symptoms such as congestion or sneezing could be a symptom of allergies, a condition called allergic rhinitis. Or, as you mention, it is sometimes linked to nonallergic rhinitis. Nonallergic rhinitis can be due to different causes like irritation from smoke or vasomotor rhinitis, which is hypersensitivity of the lining of the nose to odors, temperature or barometric changes. There is also a condition called nonallergic rhinitis with eosinophilia, which causes symptoms similar to those of allergic rhinitis, but no triggering allergen can be found.
A runny nose with considerable postnasal drainage could be linked to chronic sinusitis. In this common condition, the cavities around nasal passages, called sinuses, become inflamed and swollen. Some people with chronic sinusitis also have sinus polyps that may make the problem worse. A runny nose that seems to affect one side of the nose more than the other side could signal an anatomical problem, such as a spinal fluid leak. When symptoms include obstruction to air flow, other conditions such as a deviated nasal septum need to be considered.
All of these causes of chronic runny nose and postnasal drainage may happen in older people, but several additional disorders that can cause these symptoms to become more frequent with age.
For example, gustatory rhinitis is more common in older populations. Symptoms of this type of nonallergic rhinitis may be triggered by eating any food, and is an exaggeration of the runny nose that we all get when we eat spicy food. It is also more common for minor temperature changes to induce a runny nose in older adults.
In many older people, the sensation of postnasal drainage may be the result of nasal airway dehydration. This can be a side effect of medications for high blood pressure, sleep disorders and bladder problems, among others. Drinking too much coffee, tea or alcohol, or not drinking enough water is also more likely to produce nasal dehydration in older adults. Finally, in some people symptoms of certain kinds of gastroesophageal reflux may be mistakenly identified as postnasal drainage.
Effective treatments are available for many of these conditions. Finding the best treatment, however, hinges on correctly pinpointing the underlying problem.
Because it has been some time since you were originally diagnosed with nonallergic rhinitis, it may be helpful to have your condition re-evaluated now. Consider making an appointment with a physician who specializes in ear, nose and throat disorders (otorhinolaryngologist) or an allergist with a particular interest in disorders of the nose and sinuses. After a thorough evaluation of your symptoms and your overall medical condition, he or she will likely be able to provide advice on how to best manage these bothersome symptoms.
— Juan Guarderas, M.D., Otorhinolaryngology/Allergy, Mayo Clinic, Jacksonville, Fla.