Postnasal Drip and a Stuffy Nose That Will Not Clear: Causes and When to Be Seen

What it involves

MedlinePlus explains that a stuffy or congested nose occurs when the tissues lining it become swollen because of inflamed blood vessels, and that it may come with nasal discharge. If excess mucus runs down the back of the throat, called postnasal drip, it may cause a cough or sore throat.

Who this is for

• Adults who feel mucus in the back of the throat and clear it all day
• Patients whose congestion has lasted more than three weeks
• People whose cough is worse when lying down
• Anyone who uses a nasal spray every day and finds the stuffiness is getting worse

What to expect

• Questions about how long it has lasted, whether it follows the seasons and which sprays or medicines you use
• An exam focused on the ears, nose, throat and airways
• A discussion of allergies, infection and irritants, and which treatments fit
• A referral for allergy testing, sinus imaging or an ear, nose and throat specialist when the problem persists

What it feels like

People describe a trickle at the back of the throat, a need to keep clearing it, a sore or scratchy throat in the morning, a cough that starts when they lie down, and a nose that is stuffy on one day and runny on the next. MedlinePlus lists postnasal drip, rhinorrhea and nasal congestion as names for the same family of complaints. None of these is dangerous on its own, but the pattern over weeks is what tells a provider whether the cause is an infection, an allergy or something else.

Common causes, as MedlinePlus lists them

MedlinePlus names the common cold, the flu and a sinus infection, saying that congestion from those typically goes away by itself within a week. Longer-lasting causes it lists include hay fever or other allergies, using some over-the-counter nasal sprays or drops for more than three days, nasal polyps, pregnancy and vasomotor rhinitis. The seasonal allergies guide, the sinus infection or cold guide and the cold versus flu guide each describe one of these.

The nasal spray trap

The encyclopedia warns that nasal sprays or drops bought without a prescription can make stuffiness worse when used for more than three days, and says not to use them more often than three days on and three days off unless a provider tells you to. Many people use a decongestant spray nightly for months without connecting it to the congestion they are trying to treat. If that is you, say so at the visit. Please do not stop a prescribed spray without asking.

What helps at home

MedlinePlus suggests drinking plenty of clear fluids to keep mucus thin, applying a warm moist washcloth to the face, inhaling steam from a shower rather than hot steam, using a humidifier, using saline spray three to four times a day and keeping the head elevated, since congestion is often worse when lying down. Antihistamines can help allergy symptoms but some cause drowsiness, and many cold products contain more than one medicine, so read the labels. Ask your provider which are safe with your other medicines.

When postnasal drip becomes a cough

A drip that triggers a cough can look like a lung problem. The persistent cough guide explains how a provider separates drip, asthma, reflux and other causes, and the sore throat guide covers the scratchy throat that follows. A cough that lasts longer than ten days, or produces yellow-green or gray mucus, is on MedlinePlus's list of reasons to contact your provider.

When to book a visit

MedlinePlus says to contact your provider for a stuffy nose with swelling of the forehead, eyes, side of the nose or cheek or with blurred vision; more throat pain or white or yellow spots on the tonsils; discharge with a bad smell, from only one side or in a color other than white or yellow; a cough lasting more than ten days; discharge after a head injury; symptoms lasting more than three weeks; or discharge with fever. Any of these is a reason to be seen soon.

Sources

• MedlinePlus: Stuffy or runny nose - adult (medical encyclopedia)
• MedlinePlus: Sinusitis (health topic)