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Nasopharyngeal Carcinoma
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Early cancers of the nasopharynx produce minimal and trivial symptoms. Local features can be divided into nasal, otological, cervical, and neurological findings. Common nasal symptoms are blood-stained nasal discharge, post-nasal drip, obstruction, cacosmia, or a smell of blood.
Exercise-induced laryngeal obstruction
Published in John W. Dickinson, James H. Hull, Complete Guide to Respiratory Care in Athletes, 2020
There is likely is to be an association between EILO symptoms and other causes of upper airway irritation. If causally linked, these observations may suggest that neural processes may play a role. One can hypothesise within this line of thinking that epithelial barrier function, afferent signalling, efferent signalling, or muscular function may affect the frequency and severity of symptoms. Other potentially relevant factors include gastroesophageal reflux; potentially via its effect as a direct irritant or as a neurologic contributing factor. Post nasal drip has also been hypothesised to contribute.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
UACS includes the spectrum of rhinosinus causes of post-nasal drip. From perennial rhinitis to the sequela of upper respiratory infections, UACS encompasses the breadth of diseases that result in posterior nasopharyngeal secretions descending to the larynx, causing an irritating feeling or “tickle” in the throat. Cough due to UACS may be nonproductive or result in small amounts of white sputum; however, UACS due to chronic sinus infections may result in purulent sputum. Typically, the cough worsens when patients assume a supine position to go to sleep, both because of positional worsening of nasal drainage and a greater awareness of the “irritation” in the absence of typical distractions one encounters during the day. Not uncommonly, patients will not be aware of a “drip,” per se, but when questioned about the source of the cough (i.e. where the cough seems to be originating), they will localize it to the throat rather than the chest. Frequent “throat clearing” may be a clue suggestive of UACS. Friends or family members may be more aware of frequent throat clearing than the patient, and frequent throat clearing may be observed during the interview. A history of allergies may be suggestive of UACS due to rhinitis, particularly if there is seasonal variation of cough frequency or severity. However, in most cases, patients are unaware of specific allergens, and skin testing may be necessary if symptoms persist despite treatment.
Exploring the clinical relevance of cough hypersensitivity syndrome
Published in Expert Review of Respiratory Medicine, 2020
Postnasal drip might be considered another treatable trait; in mouse models, mechanical stimulation of larynx by postnasal drip provokes cough [71]. However, most patients with purulent postnasal drip do not complain of cough [72]. A previous case-control study reported that neuropeptide levels, such as calcitonin gene-related peptide and substance P, in nasal secretions were increased in patients with chronic cough and postnasal drip symptoms compared to controls without those symptoms [73]. In a case-control study (n = 30), patients with typical symptoms with postnasal drip (7 of them had cough) did not have increased volume of postnasal drip than healthy controls (none had cough); the patients had an increased viscosity of postnasal drip but decreased nasopharyngeal sensitivity to air puff stimulation [74]. These findings suggest that the relationships between postnasal drip and cough may be complex, particularly in the context of chronic cough, as repeated mechanical stimulation of the larynx may have desensitizing effects on the nerves. No clinical trials have ever reported the efficacy of an intervention to reduce postnasal drip (or change the nature of secretion) on cough outcomes.
Impact of nasal conditions on chronic otitis media: a cross-sectional study in Koreans
Published in Acta Oto-Laryngologica, 2018
Kyung Wook Heo, Min Jae Kim, Jun Ho Lee
Otoscopic or endoscopic examinations that were included in the KNHANES, were performed to detect middle ear pathologies. Nasal pathologies were checked by endoscope under pre-constricted and post-constricted nasal conditions. Patients were assessed for SD, nasal polyps, interior turbinate hypertrophy, and post-nasal drip (PND). Pure tone audiometry was also performed. Allergic rhinitis (AR) was defined by a history of a clinician’s diagnosis via an otorhinolaryngological questionnaire. Otologic physical examinations were performed in subjects older than 1 year. A 0° endoscopic examination of the tympanic membrane or external auditory canal was performed in subjects older than 4 years. Nasal examinations and pure tone audiometry were performed in subjects older than 12 years. Among the data, the prevalences of nasal and middle ear pathologies were considered in the present study. In the survey, endoscopic examinations were performed by third-year residents of the Departments of Otorhinolaryngology – Head and Neck Surgery who were assigned by the Korean Society of Otorhinolaryngology – Head and Neck Surgery, and captured images were reassessed by Otorhinolaryngology specialists.
Chronic cough: Investigations, management, current and future treatments
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
I. Satia, M. Wahab, E. Kum, H. Kim, P. Lin, A. Kaplan, P. Hernandez, J. Bourbeau, L. P. Boulet, S. K. Field
UACS broadly encompasses allergic and non-allergic rhinitis (most commonly vasomotor), chronic rhinosinusitis and often presents in patients with a sensation of liquid dripping into the posterior nasopharynx. This is commonly described as post-nasal drip. There is a lack of strong evidence to guide therapy, however, guidelines recommend a trial of first/second generation non-sedating antihistamines (eg, brompheniramine, fexofenadine, bilastine, rupatadine), intranasal steroids, ipratropium and/or decongestants.78–80 The latter should be used with care in patients with hypertension and are not recommended for long-term use. Patients with severe allergic rhinitis may undergo allergen immunotherapy, but its effects on cough have not yet been studied.