Chronic Rhinitis.
Synonyms:—Catarrh; chronic nasal catarrh; ozaena. Definition:—A chronic inflammation of the post-nasal mucous membrane, persistent in character and intractable to the usual remedial measures, while the atmospheric conditions continue, which induce it. These are usually damp atmosphere, with abrupt changes in the temperature.
Etiology:—Frequent attacks of acute coryza will result in this disease. The atmospheric conditions above referred to are the commonest causes. The continued inhalation of damp air, which contains dust or other irritating substances, or the presence of constitutional dyscrasia. Foreign bodies which have been introduced into the passages and not discovered, or a foreign growth, as a polypus, or a deflection of the septum nasi, all act as inducing causes.
Symptomatology:—The disease may occur with hypertrophy of the mucous membrane, with a persistent discharge, or there may be atrophy of the mucous membrane, with extreme dryness.
In the hypertrophic form there is marked thickening of the mucous membranes, with hypertrophy of the turbinated bodies, resulting in engorgement and a thick mucus discharge. When ulceration occurs, in protracted cases, the discharge becomes purulent and fetid (ozaena). There is impairment of the sense of smell and often of hearing also, and the patient may be obliged to breathe through the mouth entirely, or through one nostril at a time; the nasal obstruction may be influenced somewhat by gravitation, the patient awakening in the night, lying on the right side, will find that he can breathe only through the left nostril. After turning over and lying on the left side for awhile the left nostril becomes occluded and the right nostril is freely open.
In the atrophic form of this disease the passages feel dry and often stiff and sore. An examination shows that the passages are dilated or widely open; there is some discharge, but this usually dries at once, forming a crust, with an odor which is extremely offensive. The sense of smell may be entirely lost, the membranes are usually pale and sometimes on inspection appear dry and glistening.
Diagnosis:—The disease is not likely to be mistaken for any other chronic condition. An examination of the post-nasal passages will quickly determine the presence of those factors which are characteristic of this disorder if the usual manifestations are obscure.
Treatment:—Much is accomplished in the relief of this disease by the use of appropriate measures, but a cure is almost impossible in those localities where the atmosphere is constantly moist and the temperature is liable to abrupt and sudden changes. If a cure is accomplished a relapse will occur with but little provocation. The patient becomes liable to relapses in cases that are at all prolonged in character.
In the hypertrophic form of the disease, if there is an excessive mucus discharge, the internal use of five minims of turpentine on a lump of loaf sugar, four times daily, will be of much service. In cases where there is persistent sneezing, with a constant inclination to blow the nose, and a profuse watery discharge, five drops of euphrasia every two hours will give relief. Dulcamara will benefit many cases, especially those that are dry in character. These are relieved also with two minims of jaborandi every two or three hours. The extreme dryness and atrophy may be greatly benefited with this remedy. Chronic thickening, affecting the senses of hearing and smell, is benefited by the use of salicylate of sodium in five-grain doses. Where the thickening and hypertrophy becomes suddenly aggravated and extreme, especially if there be constitutional dyscrasias present, calcium sulphid, to full saturation, may be given. When the membrane is dry, with constant irritation, especially if the condition has extended to the bronchial tubes, with a dry, irritating cough, from two to five grains of ammonium chlorid may be given in solution every three hours.
In the hypertrophic form, especially where there is an excessive discharge, camphoric acid may be given in five grain doses four or five times each day. A one per cent solution of the acid may be used as a douche at the same time. Or, if the nasal passages are dry and irritable, the normal salt solution may be applied as a douche, it may be used very warm when there is much hypertrophy.
The condition of the general system should always be looked into. I am confident that the presence of an excessive quantity of uric acid in the fluids of the body has much to do with the presence of nasal catarrh, and this condition in the system—lithemia—should have careful attention. The avoidance of nitrogenous food is sometimes beneficial.
