Postnasal drip (PND), commonly regarded as a phenomenon wherein nasal fluid drips into the pharynx, is one of the main symptoms of chronic
sinusitis and other nasal lesions. This definition is controversial, however, because some patients have PND with no evidence of fluid either in the oropharynx or around the choanae. Among 220 patients in whom PND was diagnosed at the University of Tokyo Hospital between January 1996 and December 1997, 19 (8.6%) had hard-to-recognize PND on routine examination. Through careful observation, responsible lesions could be identified in all patients with hard-to-recognize PND. Seven patients had latent chronic
sinusitis, 5 had nasopharyngeal lesions, such as Tornwaldt's
cyst and
inflammation, 3 had "old man's PND", 2 had "reflux PND", and 2 had
polyps around the sphenoid ostium. Five patients received no treatment. In the other patients, medical
therapy, mainly long-term treatment with low doses of
macrolides, now regarded as a standard regimen for intractable chronic
sinusitis in Japan, was effective in alleviating symptoms regardless of the cause.