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Chronic Rhinitis.

Problems:

[image:14538 align=left hspace=1]Synonyms.—Chronic Nasal Catarrh; Rhinitis Hypertrophica; Rhinitis Atrophica; Ozena.

Definition.—A chronic inflammation of the nasal mucous membrane, often involving the nose and pharynx, and characterized by hypertrophy of the membrane and turbinated bones, an offensive secretion, and an impairment or loss of the sense of smell.

Etiology.—The most common cause is recurring attacks of the acute form, though syphilis and tuberculosis come in for a large share in giving rise to the disease. The inhalation of irritants, mentioned as a cause in the acute form, may also be responsible for the chronic variety. The disease is most common in children, and not infrequently is due to adenoids in the naso-pharynx.

Pathology.—The pathological changes noted in chronic nasal Catarrh depend upon the form or stage of the disease, there being three varieties:

1. In simple chronic catarrh there is irritability of the mucous membrane, which becomes congested and swollen, causing more or less obstruction to the free passage of air. There is a profuse secretion of a thick, tenacious mucus. In time the inferior turbinate becomes hypertrophied, and the disease passes from the simple form to the hypertrophic.

2. In the hypertrophic variety, which usually follows the above mentioned form, there is thickening of the mucous membrane and enlargement of the inferior turbinated bodies, so that the passage is nearly or quite obstructed, the patient breathing through the mouth. Often adenoids develop in the naso-pharynx, which necessitates mouth-breathing altogether. There may be swelling of the Eustachian tubes, which renders the patient dull of hearing. As in the simple form, there may be profuse secretion of thick, viscid mucus.

3. In atrophic rhinitis there is thinning of the mucous membrane, with consequent widening of the air-passage. The membrane is pale, relaxed, and secretes an offensive, purulent material, which, drying, forms crusts or scabs, and, when removed, leaves an excoriated surface. In this form the sense of smell is destroyed.

Symptoms.—The most common and prominent symptom is the obstructed nasal breathing, due to hypertrophy of the membrane and turbinated bodies. The patient sleeps with the mouth open, the breathing being sonorous. The secretion drops into the naso-pharynx, and is removed by frequent hawking.

An examination of the nose reveals its true character. In the atrophic form, the fetid odor is the most characteristic symptom. Nasal breathing may be somewhat difficult owing to dried crusts; but when these are removed, the nasal passages are found abnormally roomy. The sense of smell is destroyed.

Inspection shows the mucous membrane thin and covered with grayish or yellowish crusts, the removal of which leaves an excoriated surface, though seldom an ulcer. Severe headache is quite common in this form.

Treatment.—Where there is much hypertrophy of the mucous membrane, and especially of the turbinated bodies, the patient should be referred to a specialist, as operative measures promise more speedy relief. In the early stages, and when the hypertrophy is not marked, the general practitioner may treat the case quite successfully.

The treatment will be both local and general. Where the patient is able to travel, mild, equable, and dry climates should be advised.

Cleanliness is of great importance in this disease. To attempt to medicate a case of chronic rhinitis without thoroughly cleansing the passages is to court defeat. This may be accomplished by the use of an atomizer throwing a coarse spray. Boracic acid, a three-per-cent solution of pyrozone, a normal saline solution, a Seller's tablet dissolved in water, and glyco-thymolin, are among the best remedies for this purpose. Having thoroughly cleansed the nostrils, we should use a tonic, astringent, or antiseptic solution, according to the condition of the membrane, care being used to avoid strong solutions. Hamamelis, potassium chlorate, and similar remedies will prove useful. For ozena, a douche or spray of glyco-thymolin, well diluted, will give good results.

Nearly all cases will need general treatment as well as local. There is either defective metabolism or impaired digestion, usually both, and the treatment will be to break down feeble tissue, stimulate the excretory organs to eliminate the detritis, and at the same time supply good, nourishing material, properly prepared, to build up the system.

Well-regulated outdoor exercise increases oxidation of the tissues, and also sharpens the appetite. A good tonic, like nux vomica and hydrastis or the compound tonic mixture, will be of great benefit.

If syphilitic, echinacea, Donovan's solution, potassium iodide, and like remedies should be given. If tubercularly inclined, a change of climate, outdoor life, and iron and arsenic, the hypo-phosphites, etc., would be suggested.


The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.



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