ABSTRACT
Background: Nasal endoscopic features of post nasal drip (PND)
is well described but not formally studied. This study aims to assess
the nasal endoscopic features of PND among rhinitis.
Design: Cross-sectional study
Settings: Otorhinolaryngology (ORL) outpatient clinic at a
tertiary referral center.
Participants: Adults (18 years and older) with chronic rhinitis
grouped into either “Rhinitis with PND” or “Rhinitis only”.
Main outcome measures: The endoscopic features of PND were
scored as: Secretions in the posterior nasal cavity (Yes/no), erythema
in the nasopharynx (none, roof only, diffuse), hemorrhagic spots
(yes/no) and granular posterior pharyngeal wall(patchy/diffuse) and
compared between groups.
Results: There were 98 patients included (age 32.32±11.33, 61.2
% female, 61.2% PND). Presence of secretions in the posterior nasal
cavity was associated with PND (“Rhinitis with PND” vs “Rhinitis
only”, 78.3 v 55.3%, p=0.02). This gave 78.3% sensitivity and
likelihood ratio positive of 1.41 to predict bothersome PND among
rhinitis patients. The other nasal endoscopic features were not
associated with PND.
Conclusion: Secretions in posterior nasal cavity supports PND
among rhinitis patients. Further studies to assess the endoscopic
features of PND in other patient populations are needed.
Keywords: laryngopharyngeal reflux, postnasal drip, rhinitis,
nasal endoscopic, bothersome, inflammation, reflux symptoms index,
reflux findings score
Key points : rhinitis, nasal endoscopic features, postnasal drip
sign, secretions posterior nasal cavity, quality of life
INTRODUCTION
Postnasal drip (PND) is the feeling of mucus secretion at the back of
the throat. It was first defined as a sense of fullness deeply seated in
the back of the nose with cough on intervals, frequent hawking and
spitting pellets of mucus (1). PND has also been
referred to as chronic inflammation of the lining membrane of the
nasopharynx, giving rise to a viscid secretion, causing disagreeable
sensation, and make patients hawking and clearing the throat(2). Conditions associated with PNDs are rhinitis
(allergic or non-allergic), chronic rhinosinusitis (CRS) and
laryngopharyngeal reflux (LPR) (3).
Rhinitis patients are not routinely evaluated for PND as the physicians
are focused on the other cardinal symptoms of rhinitis. Determining the
cause of PND may be challenging as it may also be due to LPR.
Furthermore, the diagnosis of LPR is ambiguous and mostly relies on the
reflux symptom index (RSI), reflux finding score (RFS) and trial of
proton pump inhibitor (PPI) in the everyday clinical setting(4,5). Physicians need to be aware that PND may also
be due to rhinitis itself but there are not enough clues to help
physicians determine presence of PND among rhinitis.
Nasal endoscopy is a tool widely used by rhinologists. The nasal
endoscopic feature of PND has been described as redness of the
nasopharynx, secretions in the choana, hemorrhagic spots in the
nasopharynx and granular posterior pharyngeal wall(6,7). However, these features that are seen via
endoscopes have not been formally studied among rhinitis. These clinical
signs may be useful to support the symptom of PND.
The present study aims to assess the usefulness of nasal endoscopy to
determine the signs of PND among rhinitis. This may guide clinicians to
identify the nasal endoscopic signs of PND in relation to rhinitis,
ultimately guiding appropriate therapy.
MATERIALS AND METHODS