Sinus Drip and Dry Mouth

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Sinus Drip and Dry Mouth

Question:
I have a leaking in my sinuses which leaks down the back of my throat. My saliva is very thick, which leaves my mouth dry all day everyday. I drink a sufficient amount of water daily to combat this, however its been to no avail.
My breath stinks all day. Constant brushing does nothing to help.
Please Advise.
Thank You.
Answer:
I would advise a consultation with an ENT specialist. You could have a sinus infection and or silent acid reflux.
Hope this clears things up.
Scott D. Gold MD
If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Salty Post Nasal Drip with Headaches After Surgery

Question
For nearly 3 years I have been getting salty post nasal drip with headaches. I had a CT scan of my sinuses which showed only mild to moderate mucosal thickening. I had FESS bilateral unicectomies, middle meatal anthrostomies and anterior ethmoidectomies.

I wish I never had the surgery done, the salty drainage is so bad, I’m constantly coughing in tissues and have a constant high-pitched ringing in my ears. I have really bad anxiety and depression since the operation. I feel so ill everyday. I’m 22 year old female and it’s ruining my life.

I think I might have a csf leak. Had beta 2 transferrin test, which came back negative. I coughed the fluid from the back, I dont get any out the front of my nose. My recent CT scan doesn’t show any evidence of a leak. Been tested for allergies and am not allergic to anything.

What can I do? Thank you.

Answer
CSF Leak HeadacheThanks for your note.
It is really hard to let you know without a complete examination, and it sounds like you have been cared for appropriately without the results one would really hope for or expect.
I definitely would suggest further evaluation for csf leak or increased intracranial pressure.
Any medications you are taking need to be looked at. At the NY Sinus Center, we would also look whether there is Gastro esophageal reflux as high as your sinuses causing these symptoms, usually by Restek pH monitoring in the nasal cavities.
Unfortunately, very often sinus problems are complex, rather than straightforward, and treatment really requires understanding the cause of one’s problems.
Robert Pincus MD
Co-director NY Sinus Center
Let’s clear things up
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Post Nasal Drip

Question:

Hey Robert,

I have had a problem with post nasal drip since May. Every doctor I go to tells me they don’t know what’s wrong. I’ve been prescribed Nasonex and Augmentin, but both made the problem worse. I have a sore throat, my tonsils hurt, and my post nasal drip is worsening. Even as I write this email, I’m hocking up mucous to spit out. It won’t stop… If you have any thoughts, please let me know. I will greatly appreciate it.

Answer:

As you know, to really give you an accurate diagnosis would require your being seen and evaluated. However, we have found that many patients with your complaints have a post nasal drip due to acid reflux. We call this “silent reflux” when stomach acid reaches the back of the throat and the nose, causing irritation and post nasal drip even if patients don’t have heart burn. The body then makes mucous in response. You can see more about it under sinus treatment on the nysinuscenter.com website. This can often be diagnosed on examination alone, but at times we recommend pH testing. This is a test in which a thin wire that measures acidity is placed into the back of the nose.

Treatment for silent reflux includes following an antireflux diet (not eating 3 hours before bedtime, limited caffeine, chocolate, alcohol, fatty foods, peppermint and a few others) and 6-12 weeks of antacid therapy (usually 2 OTC prilosec or prevacid 30-60 minutes before breakfast)- Sometimes evaluation of the esophagus is needed to make sure there are no more worrisome problems in patients with silent reflux.

Other evaluations I would suggest, if not done, include nasal endoscopy, culturing any nasal discharge and perhaps imaging the sinuses by CT scan to make sure there is not a persistent sinus infection or other such cause of your symptoms.

If you’re in the NY area, please make an appointment, and I think we should be able to help. If not, please see an ENT doctor who specializes in sinus problems near home and ask about the above possibilties..

R Pincus MD

Associate Professor Otolaryngology

NY Sinus Center

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Is Post Nasal Drip Curable?

Question: Is there a post nasal drip cure? Can you get antibiotics for it? Aside from sinus infections, what are the other causes for it?

Answer:

The short answer is yes, post nasal drip is curable once one finds the cause. Post nasal drip is one of the more common symptoms people complain about to their Ear Nose and Throat doctor. Much of the time doctors consider this a diagnosis. It is not a diagnosis, but a symptom with many causes. The actual post nasal drip cure starts with understanding the sinuses and the causes of post nasal drip.

We make mucous in the nose and sinus cavities, about a quart a day. It serves as a lubricant, think motor oil, that traps particles in the nose- dust, virus, contaminants, bacteria- and is swept back by cilia into the back of the nose and then down the throat into the stomach. The stomach acid then destroys or inactivates these contaminants. The mucous is usually a thin lubricating layer.

However, sometimes we make the wrong consistency of mucous- think thick old motor oil- and there are multiple causes that should be able to be diagnosed by your ENT or sinus doctor.

One of the more common causes of post nasal drip is gastric reflux. If acid comes up as high as the nose or throat, the membranes make extra mucous, trying to delicate nasal lining tissues from the acid. Patients often feel the need to clear the throat with this.

A sinus infection can cause post nasal drip. In this case the examiner can see pus coming out of the sinus openings, being swept down the throat.

Allergies can cause post nasal drip by making “the wrong kind of mucous”. Typically with allergic nasal conditions one may make excess watery- or at other times overly thick- mucous that one feels in the throat.

Mucous can become thick from drying and cause a post nasal drip. This can occur with dry air- such as heated air in cold weather or often from drying medication such as a diuretic (water pill).

Any individual can have one or more of these problems simultaneously. Appropriate treatment, when aimed at the cause or causes, should be able to help alleviate your post nasal drip.

Robert Pincus MD
NY Sinus Center

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