The after-trcatment is simple. The patient should be kept in-doors for a period of a week and the nose occasion ally sprayed with a warm alkaline solu tion. If reactionary symptoms appear, they should be met in accordance with their nature and severity. If confident that the adenoid vegetations have been thoroughly removed, the nose and phar ynx, etc., should be examined for en larged tonsils, spurs, deflection of the septum, and chronic hypertrophies of the mucous membrane. If one or more of these conditions are found to exist, the trouble should be corrected, to avoid en couragement of recurrence of lymphoid hypertrophy.
Acute Naso-pharyngitis.
Symptoms.—In the first stage of this affection a more or less marked sense of dryness in the parts, and, perhaps, pos sibly some difficulty in swallowing, is ex perienced. In the course of a day or two a mucous discharge appears which at first is thin and gradually becomes thicker and more purulent.
The annoying symptom which early establishes itself is the dropping of secre tions into the throat, causing a constant desire to hawk and expectorate. As the disease progresses the voice in not a few instances becomes altered. Hoarseness or "raspiness" is complained of. If the Eustachian tubes are implicated in the morbid process, tinnitus, impaired vocal resonance, darting pains along the Eu stachian tract, etc., are also complained of.
Symptoms of acute rhinitis or pharyn gitis may also appear when acute ca tarrhal inflammation of the naso-pharynx coincidently exists with one or both of these diseases.
The course of the disease is variable. Sometimes the mucous secretion ceases in a few days, and the mucous membrane returns to the normal, while again, not ably in debilitated persons, the malady lingers on for weeks or months, eventu ally assuming a subacute or chronic character.
Among the complications to be en countered is involvement of the Eu stachian tube and of the middle ear. Sometimes the orifices of the tube are found red and swelled and covered with secretions; a feeling of fullness and bub bling in the ear is produced upon blow ing the nose. Sero-mucous and puru lent middle-ear inflammation may fol low such a condition.
Etiology.—Acute tiaso-pharyngitis is sometimes produced by an extension of inflammation from the nasal passages or from the pharynx. The various CaUSOS inducing acute inflammation of the mu cous membrane of the nose—such as in halation of dust, climatic changes, erup tive fevers, exhaustive diseases, etc.— also play an important etiological role.
Among the local causes chiefly to be mentioned is tbe presence of adenoid or lymphoid overgrowths. That such a condition forms a predisposing cause of the attacks cannot be questioned; this is particularly during childhood and youth, the periods when acute naso-pharyngitis is most common. Acute inflammation of the naso-pharynx then frequently gives rise to purulent rhinitis or inflam matory disturbances of the fauces.
Pathology.—The existence of such a disorder as acute idiopathic catarrhal inflammation of the naso-pharynx is not accepted by all observers. That it does can be substantiated by clinical evi dence. This is especially true when the sympathetic system becomes influenced through some factor tending reflexly to dilatation and engorgement of the blood-vessels. It is due, in the majority of cases, according to Sajous, to exten sion of neighboring disorders through contiguity of tissue.
Prognosis.—Of utmost importance is the early recognition and treatment of this affection. If the disease is neglected and allowed to run on unattended, it is destined, in the majority of cases, to re solve into a chronic catarrhal disorder: a persistent and troublesome malady.
Treatment.—In the early stage, when pain and dryness of the parts are present accompanied by general malaise and a febrile movement, considerable can be accomplished toward alleviating suffer ing and aborting the disease by the ad ministration of small doses of apoinor phine (7„ grain) frequently repeated. Should there be any hepatic torpidity or digestive disturbances, a mercurial, fol lowed in four or six hours by a saline purgative, should at once be adminis tered.
Warm alkaline lotions, applied in the form of a spray to the nasal passages or post-nasal spray, prove grateful and beneficial. A solution of cocaine (4 per cent.) applied in the same manner af fords immediate comfort and aids in con trolling vascular engorgement. After the disease has passed the stage of acute hyperminia, and muco-purnlent secre tions appear, astringents or alteratives are indicated. Sulphate or sulphocarbo late of zinc and silver nitrate applied with a pledget of absorbent cotton, at intervals of twenty-four or forty-eight hours in solution of the strength of 2 per cent. or 4 per cent., are especially valuable. Before employing silver solu tions the larynx should bc cocainized to avoid the laryngeal spasin that would follow the dropping of some of the solu tion into the cavity.