On the Nose

Answers to your questions about postnasal drip, sinusitis and more

By Shelby Topp, MD, otolaryngology (ENT)

Man blowing his nose in bed
Q: What causes postnasal drip, and what can I do about it?

This may be a gross thought, but your nose and sinuses typically produce 1-2 quarts of mucus every day, which you swallow without really noticing. Inflammation from allergies or infections can increase or thicken this mucus and make it more noticeable. So can changes in temperature or humidity, strong odors, smoke and environmental irritants, medications, foods, and even just the thought of eating. All of these together account for the very common complaint of postnasal drip, which is often accompanied by congestion.

Addressing it starts with eliminating as many of the causes as possible. Decongestant sprays (e.g. Afrin) or oral decongestants (e.g. Sudafed) can offer short-term relief, but shouldn’t be used for more than a few days due to the high risk for rebound congestion. For long-term management, the simplest remedies are nasal saline spray or sinus rinses (e.g. neti pot). These can be combined with allergy medications and nasal steroid sprays like Flonase or Nasacort. Other options are available by prescription if all of the above fail to control the drainage.

Q: Why does my nose get stuffed up at bedtime?

Known as “dependent nasal congestion,” this stuffiness is a normal consequence of gravity and vascular tone. Gravity promotes pooling of blood and fluids in whichever part of your body is lowest, including your nasal tissues when you’re lying down. The turbinates — fleshy structures on the inner walls of the nose that filter and humidify incoming air — are particularly prone to swelling and shrinking. When this pooling and swelling joins forces with other factors, such as active colds or allergies, congestion symptoms are common. Some people also just have naturally larger turbinates — these can be surgically reduced if they are causing pronounced congestion and sleep issues. 

One way to address dependent congestion is to perform a saline sinus rinse near bedtime. This won’t eliminate the effects of gravity, but it can soothe the nasal lining to minimize the extra effects of mucus secretions in the nasal cavity.

Q: What is sinusitis?

This inflammation in the lining of the sinuses can cause a variety of symptoms, from facial pressure or pain to nasal congestion, increased mucus, headache, fever, and changes in the sense of smell. Acute sinusitis can be caused by viral or bacterial infections, allergies or other inflammatory issues. It usually resolves in about a week, but may go on for up to four weeks. If it lingers or worsens, antibiotics may be prescribed. 

Chronic sinusitis, where symptoms last longer than a month, often requires long-term anti-inflammatory treatments, and sometimes surgery if medications aren’t enough. Some people have mixed patterns of acute episodes and chronic baseline dysfunction.

Q: Can I prevent sinusitis?

We can’t control all of our exposures or immune responses. But practicing good hand and nose hygiene (e.g., wash your hands well, don’t touch your face) can help you avoid catching a cold, the most common cause of sinusitis. Fewer acute episodes means fewer chances to progress to chronic sinusitis.

If you have frequent sinus infections, a regular nasal anti-inflammatory regimen can help you stay out of trouble. Oral steroid medications also may help break the cycle.

Q: When should I see an ENT?

If regular sinus symptoms are taking a toll on your work, school or life, a visit with an ENT may be beneficial. All roads do not necessarily lead to surgery. Recent advances in tailored therapies, medications and minimally invasive procedures could offer help.

 Q: What is your No. 1 tip for everyone to prevent sinus problems?

I recommend saline sinus rinsing so often that I sound like a broken record. It’s the rare “freebie” — no drugs, no drawbacks, just a very natural way to promote normal sinus function. For those with chronic sinusitis, a daily rinse is a no-brainer.

Q: How do you perform a sinus rinse? Is it uncomfortable?

When done correctly, a nasal rinse shouldn’t be uncomfortable, although it may feel unnatural at first. For the most comfort, I recommend using warm water (either distilled or boiled and cooled — never straight from the tap) for the rinse solution. To perform the rinse, lean straight forward, close your mouth, and breathe out gently through your nose while gently squeezing the fluid into one nostril — the water should spill out the other nostril. Don’t squeeze too hard, and don’t breathe in while squeezing, or you might send fluid into your ear or down your throat. You can find how-to videos on YouTube to see how to do it right. Give it a try — your nose will thank you.