The diagnostic workup of patients with a primary complaint of post-nasal drip

Abstract

Background: Post-nasal drip (PND) is likely multifactorial in etiology which may be attributed to excessive sinonasal secretions or an increase in mucous viscosity from chronic sinusitis or allergic rhinitis. Increased throat sensitivity due to inflammatory changes have been postulated as a possible cause, which may be secondary to laryngopharyngeal reflux (LPR). Methods: Patients presenting with a primary complaint of post-nasal drip were prospectively enrolled into the cohort study. All patients underwent nasal endoscopy, flexible laryngoscopy, in-vitro allergy testing, and computed tomography (CT) imaging. Patients were also asked to fill out a SNOT-22 questionnaire and a reflux severity index (RSI) form. Results: 33 patients were enrolled in the study of which 22 completed all necessary procedures. In our cohort of patients the average SNOT score was 43±22, and the average RSI was 22±7. Twenty-one of the 22 patients had RSIs consistent with LPR. Reflux finding scores (RFS) as evaluated and averaged between two laryngologists found that all patients in the cohort met criteria for LPR with an average RFS of 12.6±2.1. Fourteen of the 22 patients had a positive RAST. Seventeen of the patients in the cohort had CT scans that were normal. The average Lund Kennedy score was 0.9±1.4 with 14 of the 22 patients having unremarkable nasal endoscopies. Conclusions: Patients with PND benefit from consideration of empiric treatment with PPIs, dietary modification given the high rates of LPR. Consideration should also be given to allergy testing prior to any consideration for CT imaging.