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