The Nasal Endoscopic Features of Postnasal Drip: A Cross Sectional Study

Abstract

Introduction Patients with chronic rhinitis suffer from postnasal drip (PND) but this symptom is not well addressed. Nasal endoscopy may aid in identifying PND. Well described endoscopic features of PND are presence of secretions in the posterior nasal cavity, diffuse erythema, and hemorrhagic spots in the nasopharynx, but these have not been formally studied. Objectives The present study aims to assess the association of nasal endoscopic features with PND among rhinitis patients. This will guide clinicians to interpret the nasal endoscopic findings appropriately. Methods Adults (≥ 18 years old) with chronic rhinitis were consecutively recruited at an Otorhinolaryngology outpatient clinic in a tertiary referral center. The patients were grouped into either "Rhinitis with PND" or "Rhinitis only." 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), then were compared between groups. Results There were 98 patients included (age 32.32 ± 11.33 years old, 61.2% female, 61.2% PND). Presence of secretions in the posterior nasal cavity was associated with PND ("Rhinitis with PND" versus "Rhinitis only," 78.3 versus 55.3; p = 0.02; Odds ratio: 2.81; 95% confidence interval [CI]: 1.08-7.32). Diffuse erythema of the nasopharynx was more frequent in "rhinitis only" compared with those with PND (76.3 versus 53.3%; p = 0.02). Hemorrhagic spots were equally present in both groups (11.7 versus 18.4%; p = 0.35). Conclusion Presence of secretions in the posterior nasal cavity may indicate bothersome PND among patients with rhinitis. Diffuse erythema of the nasopharynx and hemorrhagic spots are a nonspecific sign of inflammation.

Keywords: PND; laryngopharyngeal reflux; nasal endoscopy; nasal mucosa; postnasal drip; rhinitis.

Fig. 1

The reference image used by study blind assessors to grade the presence of secretions in the posterior nasal cavity. Presence of secretion is defined as secretions in the posterior nasal cavity or the choana either near septum (a) or eustachian tube which may be thick whitish (b) or clear secretions (c).

Fig. 2

The reference image used by study blind assessors to grade the redness roof of nasopharynx. Redness of nasopharynx is defined as erythematous mucosa over nasopharynx. It has been graded as Grade 0 which is no redness of nasopharynx (a). Grade 1 (roof only), defined as redness involving only roof of nasopharynx, (roof defined as the level of above the upper 1/3 ^rd edge of the torus tubarius (b). Grade 2 (diffuse), defined as redness extending beyond the roof of the nasopharynx (c).

Fig. 3

The reference image used by study blind assessors to grade the presence of hemorrhagic spots in the nasopharynx. It is defined as multiple reddish spots in the nasopharynx. It will be graded either as absent (a) or present (b).