Why Does My Throat Always Feel So Phlegmy?
Here’s what to do if postnasal drip gets out of control.
Think about what it feels like when you need to clear your throat—when there’s a little puddle of mucus back there just waiting to be hacked up or swallowed. That mucus is known postnasal drip and, for me, it’s more than just an occasional visitor. I think I swallowed phlegm at least three times while writing this sentence. So what’s the deal? And if you've been feeling the same thing, what can you do to get rid of it?
Why we make postnasal drip
Although I often think of postnasal drip as an annoyance, it’s an important protective substance. Postnasal drip is made by the mucus membranes in our noses, says David M. Poetker, a professor in the division of rhinology and sinus surgery at the Medical College of Wisconsin.
“The nose is frequently mistaken for being just for the sense of smell, but the sense of smell is actually pretty low on the list as far as its importance,” Poetker says. “It’s really a staging area for the lungs, so it helps warm and humidify the air that we breathe.” The air we inhale typically has a relative humidity of about 50 to 60 percent, but by the time this air reaches the back of your nose, your nose has brought it closer to 90 percent humidity and warmed it to body temperature, Poetker says. This optimizes air exchange in your lungs.
“The example I always give to my patients is when you walk outside in a January morning in Wisconsin and take a deep breath through your mouth, it hurts your lungs and actually makes you cough," he says, "whereas when you take a slower, deep breath through your nose, the air gets warmed and humidified, and so it doesn’t hurt."
Nasal mucus also traps dust, pollen, and pollution, Poetker says. Those would-be invaders stick to mucus and drain down the back of your throat instead of going into your lungs, where they could otherwise cause irritation. Your mucus membranes not only have mucus glands, but also little hair fibers called cilia, which play an important role in this natural cleaning process known as mucociliary clearance, Poetker says.
“You produce the mucus, and then the hair fibers sweep the mucus toward the back of the throat, and all the sinuses are geared to drain toward the back,” Poetker says. “So, it’s not designed to drain toward the front at all; it drains toward the back of the throat, and so that’s why we have postnasal drainage.”
The average nose makes between two and three ounces of mucus per day, but you can make up to 15 ounces if your nasal mucus membranes go into overdrive, Poetker adds.
Why we sometimes make too much mucus
If you're allergic to something and it gets trapped in your nose, it will irritate the insides, says Mas Takashima, director of The Sinus Center at Baylor College of Medicine. Or, if you live in a highly polluted area, pollutants can get trapped in your nose and cause similar problems. “The body’s like ‘hey, something is irritating my nose; I have to flush that out,’” he says. “Then the body starts producing a lot of mucus to try to cleanse the nose.” Sinus infections and colds can also trigger a mucus overload.
When is this all too much gunk? “I usually tell patients that whenever you can feel it, then it’s too much,” Poetker says. “It’s either a larger volume than it should be, or it’s thicker than it should be.”
Perceptible postnasal drip can be annoying, and research shows that it can be associated with chronic cough. When you’re lying down or sleeping and have a lot of postnasal drip, mucus can drain into your windpipe and lungs, Takashima says. This can irritate your lung tissues and make you hack.
Throat and ear pain can also be secondary symptoms of excess postnasal drip. “That constant irritation of the postnasal drip going down the back of the throat can cause pretty significant throat pain in some of our patients,” Takashima says. The same nerves that make your throat hurt can also make your ears ache, so sometimes patients think they have ear infections, but Takashima finds that the problem is actually excess mucus in the back of their throats.
Hoarseness can also be a problem with excess postnasal drip, Poetker says. This can be a hassle for people who talk for a living, such as customer services representatives, teachers, physicians, and attorneys.
What you can do about postnasal drip
If postnasal drip is bugging you, your doctor can help you identify the cause and find a treatment to slow down the drip. (You don’t want to stop it altogether because of its important protective functions, Poetker says.)
Allergies could be the first thing to consider: Excess postnasal drip is a common symptom of allergic rhinitis, research shows. Commonly known as hay fever, allergic rhinitis affects 40 to 60 million Americans, according to the American College of Allergy, Asthma, & Immunology. If you tend to have other allergy symptoms and this seems to be a likely cause of your postnasal drip, your doctor might recommend a steroid nasal spray such as fluticasone, or an antihistamine spray or a combination spray, Poetker says. They can make a big difference, but it could take weeks or months before you feel it.
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Allergy testing might also be recommended, Poetker says. “If there is uncertainty, or there is something the patient could potentially avoid easily and improve their symptoms," he says, "then allergy testing might be worthwhile."
Acid reflux can also be an issue for people with chronic sinus troubles and postnasal drainage, Poetker says. “Throat clearing can be a symptom of reflux that can mean that there is mucus on the vocal cords or even swelling on the vocal cords, the sensation of mucus being on the throat frequently,” he says. In that case, reflux treatments might be worth a shot.
For some people, air pollution contributes to postnasal drip problems, too, Takashima says. “Allergies of course are the most commonly talked about issue, but if you also live in a very polluted area, there can be a lot of irritants in the air that can irritate the nasal mucosa.”
If you have allergies, take a shower before bedtime, especially when pollution and ozone levels are elevated, Takashima says. “I know many people like to take showers in the morning, but it actually makes sense for those people to take a shower right before they go to bed," he says, "because if you don’t, all that sticky pollen will be on your hair and skin will be rolling around in your bed all night with things that could potentially irritate you."
Takashima also recommends that some patients do a once-daily saline rinse with an 8-ounce sinus rinse bottle. These are over-the-counter plastic bottles that you fill with an included salt packet and distilled water and then flush your nose, Takashima says.
Saline nasal sprays can also flush irritants from your nose, Poetker says. If your nasal passages are sensitive, consider the products sold in a pressurized metal can instead of the plastic squeeze bottles—the former don’t contain potentially irritating preservatives, while the latter do, he says.
Less commonly, nasal problems can be caused by a miscommunication between your brain and your nose. “The other thing that we sometimes see is the brain unfortunately telling your nose to produce more mucus than it should, and that’s called vasomotor rhinitis as opposed to allergic rhinitis,” Takashima says. “We don’t really know why that occurs, but in some people it’s after certain activities such as exercising or eating or in the presence of cold air, things like that can spur on the body to produce more mucus than it should. The treatment for that is completely different than the treatment for allergies.”
If your doctor suspects that you have vasomotor rhinitis, they might ask you to try a special nasal spray that blocks the faulty nerve communication between your brain and nose, Takashima says. Some doctors may also offer a new procedure that uses liquid nitrogen to stun the nerves inside the nose and reset them so that they produce less mucus, Takashima says. Another procedure can shrink mucus-producing parts inside your nose with heat.
“If things aren’t working, see an ENT doctor and see what other options can be given,” he says. “Like anything, we always recommend the least invasive options first and then go up the ladder. If there’s a simpler way to treat things, by all means, do that. But if things just aren’t working, or the course of treatment will be lifelong, talk to your doctor and see if there are other options that might be available."
If you have a lot of drainage on just one side, see a doctor—preferably an ear, nose, and throat (ENT) specialist. This asymmetrical leakage could be a symptom of a more severe problem called a cerebrospinal fluid leak, which can increase the risk of dangerous meningitis, Takashima says. One-sided drainage can also happen after certain dental implant procedures, he says. When the implant is placed into the bone of the upper molar, it can easily go into the sinus located behind the cheek. “If you’ve had a dental procedure recently, and all of the sudden you’re getting problems in your nose on the side where the dental implants, that’s also a concern to see an ENT doctor,” he says.
As for me, I suspect that good, old allergies are the cause of my postnasal drip; I’m planning to bring this up at my next doctor’s appointment, and I’ll try some saline spray in the meantime. One more thing: People with higher stress levels may also have more severe postnasal drip, research suggests, so I’ll add that to my list of reasons to start meditating more frequently.
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