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REVIEW

C URRENT O PINION

Postnasal drip and postnasal drip-related cough

Jason L. Yu and Samuel S. Becker

Purpose of review This article describes the pathophysiology and management of postnasal drip (PND) with and without cough. Recent findings PND is a common complaint in primary care and ear–nose–throat offices, and is often, but not always, associated with chronic cough. Because it lacks objective testing and its symptoms can be vague and variable, PND has become a catch-all diagnosis for a variety of nasal and throat-related symptoms. Studies have shown that the traditional pathophysiology of PND related to sinonasal disease does not clearly lead to chronic cough and that the cough from PND may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions. Summary The article summarizes the current recommendations on evaluation and management of PND as well as brings to discussion new therapies and hypothesis regarding its pathophysiology. Keywords chronic cough, postnasal drip, upper airway cough syndrome

INTRODUCTION Chronic cough is defined as a persistent cough, which lasts greater than 8 weeks. It is a common complaint with up to 40% of the population report ing a chronic cough at some point in their lives [1]. Although cough is associated with a variety of diag noses ranging from viral illness to neurological disease, isolated idiopathic chronic cough has traditionally been divided into one of three categories: cough variant asthma (CVA), gastroeso phageal reflux (GERD), or postnasal drip (PND). These three diagnoses have been termed ‘The Triad of Cough’ [2]. In fact, when smoking and angioten sin converting enzyme (ACE) inhibitor use are excluded in patients with normal chest radiographs, these three diagnoses have been associated with over 90% of all chronic cough symptoms [3]. Our review will focus on the latter of the ‘Triad of Cough’. Unlike asthma or GERD, PND does not have objective findings or diagnostic testing leaving it a clinical diagnosis [4,5].

sensation about the uvula, soft palate, and posterior part of the hard palate. The sensation is much aggravated after sleep, so that the patient wakes every morning with a sore throat; but on examination of the throat, no inflammation, ulceration, or swelling is detected. 2. Short tickling cough, coming on at intervals, especially night and morning, or if long without food or drink; but on examination of the chest no morbid sounds are present. 3. Frequent hawking and spitting of small pellets of mucus, which are not unfrequently of an orange–brown color and very tenaceous. 4. On examining the pharynx shreds of stringy mucus may often be seen hanging down from behind the velum; or the back of the pharynx is coated with brownish adhesive mucus, and sometimes, but not always, the mucus follicles are enlarged and red’ [6]. Department of Otorhinolaryngology, Hospital of the University of Penn sylvania, Philadelphia, Pennsylvania, USA Correspondence to Samuel S. Becker, Department of Otorhinolaryngol ogy, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5th Floor Silverstein Bldg. Philadelphia, PA 19104, USA. Tel: +215 662 2137; e-mail: sam.s.becker@gmail.com Curr Opin Otolaryngol Head Neck Surg 2016, 24:15–19 DOI:10.1097/MOO.0000000000000226

MECHANISM OF POSTNASAL DRIP PND was first described by a British otolaryngologist, H. Dobell, in 1866. This is his original description:

1. ‘A sense of fullness deeply seated in the back of the nose, with constant stinging and tickling

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