Post nasal drip can result from many conditions associated with the nose. But when all the recommended treatments don’t work, it might not have anything to do with the nose. When two valves in the esophagus fail to do their job, post nasal drip might signal silent reflux.
Your question about post nasal drip:
Constant swallowing and throat clearing are annoying and exhausting. I have tried two different PPIs in the last three months and neither seems to make any difference. What else can resolve this constant post nasal drip? I’ve been to see an ENT who made a referral to a gastroenterologist. I don’t have Barrett’s, but I do have a hiatal hernia and some throat inflammation.
- Symptoms: hoarseness, frequent throat clearing
- Endoscopy diagnosis: YES
- GERD stage: Stage 3
- BMI: healthy
Thank you for your question. You didn’t indicate in your question that your ENT diagnosed your condition as LPR, or silent reflux, but your symptoms certainly suggest that condition. Assuming that is the diagnosis, the lack of symptom relief from PPIs is not unusual, as we describe in an article about LPR symptoms. LPR is a result of two valve failures, the lower esophageal sphincter (LES), and the upper esophageal sphincter, as discussed in a very good article titled Extraesophageal Reflux by UC Davis Center for Voice and Swallowing.
Treating post nasal drip from acid reflux
Your BMI suggests that weight management in not necessary, but modifications to your diet may reduce your symptoms. If you haven’t yet determined your symptom trigger foods, this is the first step. You might consider our mobile app to help you track foods and symptoms during this process. We also encourage you to consider several lifestyle changes that could also have a positive impact and reduce your post nasal drip issues:
- Eat dinner early and at a minimum of 3 hours before you retire.
- Eat five, or even six, smaller meals throughout the day.
- Raise the head of your bed 7 inches, allowing gravity to assist in keeping any stomach contents from reaching the esophagus.
- Do not smoke and refrain from the use of alcohol if possible.
- Maintain proper hydration and consider using alkaline water with a pH of 9 or higher.
- Consider one of several home remedies. Although there is little scientific research to support their use, many adults with acid reflux report symptom relief.
- Adopt a GERD-friendly diet to avoid all potential trigger foods, to help you maintain a healthy BMI, and to provide adequate nutrition for a safe and healthy diet approach.
We always encourage a second opinion by a GERD expert. We highly suggest you consider an antireflux surgeon since they will provide you with every treatment option available and fully discuss the risks of each alternative. We have been disappointed in some specialties since we found that gastroenterologists typically recommend PPI therapy – and they will not discuss or encourage antireflux surgery.
Based upon a number of success stories we have heard from others with LPR symptoms, we also think you should consider the Reza Band, a new device approved in March 2015 by the FDA to treat LPR symptoms. After custom fitting of this device by your physician, it is then worn around the neck as you sleep. 85% of the adults studied experienced greater than 25% improvement in their symptoms, with the average improvement being 54%.
Finally, if diet, lifestyle changes, medications, and the Reza Band fail to manage your symptoms to your satisfaction, you should consider antireflux surgery. This has been a permanent solution for many, and with an experienced surgeon, the risks are low. Please feel free to use our online DocMatch tool and allow us to assist your to find a GERD expert in your area.
I hope you will find this information helpful!