An..ther complicating- feature in dis -),sinj. the pathology of chronic rhinitis i= to determine whether the condition kir wu as simple chronic rhinitis should be considered an entity. If by this term is meant simple intumescent rhinitis with-ut hypertrophy, no obscurity could re-ult: but this is not the idea intended to be conveyed bv anthors who describe an affection in which not even intumes ecn-c is present, and when almost the filly symptom is increased secretion.
Symptoms.—The gross appearance in nasal passages differs according to the stage of pathological change which has been reached. In the most usual ,rtn, that of intumescence, the mucous membrane appears moist, but the color varies according to the general condi t:on of the patient. In anmic patients, great bogginess of tissue is ap iarent. the color is not heightened above zl.e norrnal, and very frequently it is less reddened. Intumescent swellinLrs which. are pale in color are also an indication of pas.-:.ve congestion due to nasal obstruc tion situated posteriorlv. notice these pale anterior swellings where polypi are present, or where posterior hypertrophies arc large, and we are apt to see them in children with post-nasal adenoids. But, as a rule, in chronic rhinitis the inferior turbinatcd tissues are redder than normal. These anterior swellings differ in size from day to day; sometimes one nostril will lie almost en tirely obstructed and the other free, while at the next examination the larger swelling, appears in the opposite nostril.
-Where deflection of the septum co exists, the inferior turbinated must necessarily be smaller in the narrow nos tril than in the broader one, and it must not be forgotten that the size of the inferior turbinated body should always bear a proper relation to the size of the nasal passage. In a very spacious nos tril the turbinated structure must neces sarily be large to sufficiently exclude foreign bodies and to sufficiently saturate and warm the inspired air. Hence it should not be reduced in size even though it appears larger than normal.
With the general intumescence of the inferior turbinated bodies we may also have a degree of congestive swelling and thickening, of the soft structures cover , ing the septal partition. The touch of
the probe will demonstrate how much of this swelling is congestive and (edem atous, and how much is due to real tissue-thickening. The posterior rhi noseopic view will demonstrate swelling at the posterior end of the inferior and middle turbinated bodies, but here the color is paler and we are more apt to find a true hypertrophy of tissue. We do not often note a large amount of secretion in chronic rhinitis of the in tumescent variety except during acute coryza, or unless disease of one of the sinuses co-exists.
As a result of this long-continued con gestion we find that hypertrophy has taken place at the anterior end of the lower turbinated and the posterior end is seen to be the seat of papillary swell ings. The middle turbinated body is not so apt to be modified by hypertrophic enlargements of this character, but a chronic rhinitis here manifests itself in enlargement of bony tissue, frequently with fungoid granulations on its anterior face, or with that form of cedematous inflammatory growths -which are called polypi.
The subjective symptoms depend upon the amount of nasal obstruction and its location. The obstructing tissue may cause only temporary shininess of the nostrils, or the occlusion may be so great as to give the patient serious inconven ience during the day, and compel him to breathe through his mouth at night. Distressing symptoms—such as pain through the forehead, eyes, and cheeks —are not apt to be marked unless the accessory sinuses are involved; but we frequently hear patients complain of a feeling of dullness, dizziness, loss of memory, partial loss of sense of smell, errors of vision, closure of Eustachian tubes, impaired hearing; and, if nasal obstruction is not relieved, lie presents the symptoms' of pharyngeal and laryn aeal catarrh later on.
Etiology.—It is, perhaps, safe to say that bacteria play little or no part in the etiology of chronic catarrhal rhinitis. They have not been found beneath the surface, and even upon the surface of the mucosa they occur so sparingly that the nasal mucus is reputed to possess bactericidal powers. In chronic puru lent nasal discharge, on the other hand, the ordinary microbic exciters of sup puration play a definite r'ole.