An aqueous solution of suprarenal capsule extract (10 grains to 1 drachin.
s. tziat( +.3 solution of boric acid) topic ,. ,N }las been found to be of con siltra ..le alue in reducing the acute 1 NI t milt anti .ifilammat ion of the parts.
. idahp.,i, of per vent, pli‘ti by the patient himself every two hour,. considered as. very efficient in na so pharytil•cal catarrh. 1'. Meyjes •Gentesk. Noor het Konin. der Neder 'audit], Sept. 4. '0.21.
butptutine with oil of anise makes a %altiable application, especially itt acute exaet rhations naso-pharyngiti,. It may be diluted with lavender. This ,lionld be applied to the naso-pharynx with the cotton tuft on a curved ap plicator several times weekly. It is best to use the rhinoscopic mirror in every ca-e in which applications are made to the naso-pharyngeal region. Somers Memphis Lancet. July, .9S).
Chronic Naso-pharyngitis (Chronic Post-nasal Catarrh).
Symptoms.—The subjective symptoms are mainly due to the accumulation in the naso-pharynx of a more or less puru lent secretion, which causes coughing and hawking; while the local inflammatory disorder may cause dull headache; altered voice, taste, and smell; and temporary deafness due to the interference with the function of the Eustachian tube. The patient complains of a tendency to colds in the head, sudden losses of voice, tem porary pains, and raw sensations in the throat. lie frequently "hawks" masses of muco-pus more or less desiccated: a feature that gives him the greatest con cern. The rhinoscope shows local hyper mmia; the naso-pharynx is more or less covered with pus or dried secretions, I which, when removed, often leave bleed ing surfaces.. The vault of the naso pharynx with its adenoid cushion is gen- I erally puffed out and discharges quite ! freely. Local dryness is sometimes ob- I served.
There is often considerable elongation I of the uvula, also an infiltration and thickening of the pillars of the fauces. Laryngitis is a frequent complication, while other morbid conditions of reflex origin—such as chorea, reflex epilepsy, neuralgia, supra-orbital headache, gastric disturbances, uterine disorders, retarded development, and simple ancemia—may be induced.
When extending over a long time these cases often develop dry naso-pharyngitis. The main features of this condition, also termed "sclerotic post-nasal catarrh," are not unlike the same condition of the nasal fossm (atrophic rhinitis); it may be and often is complicated with ozmna. It may occur as a sequel to catarrhal inflam mation and be dry from the start.
Under these conditions the oro-phar ynx appears dry and lustrous; and may be covered with scales of dark-colored dried mucus. When the stage of ozmna is reached, every few days round, oval, or cup-shaped masses of dried mucus are expelled, which vary some as to color and consistence. On cleansing, the mucous membrane looks pale and atrophied.
seems to be the most favorable time for this disease to appear. The gouty, syphilitic, scrofulous, and tuberculous diatheses seem to predis pose to it, and under these circumstances it is very apt to become chronic or sub acute. Incessant use of tobacco, cocain
ism, alcoholism, diseased nasal passages, enlarg,cd tonsils, chronic gastric disease are all undoubted etiolog,ical factors. Suppurative diseases of the ethmoidal and sphenoidal sinuses where the pus flows into the naso-pharynx evidently are a cause of chronic naso-pharyngitis Chronic follicular tonsillitis and its cheesy, pus-producing deposits, and de caying and neglected teeth are also causa tive.
Cases of bilateral tubercular glands constitute over 70 per cent. of the eases personally observed, and, with the addi tion of some cases of unilateral disease, in over 80 per cent. the exciting cause of the enlargement was found in the naso-pharynx. There seems ground for the belief that of naso-pharyngeal ca tarrhs a number are in their nature tubercular. Nicoll (Glasgow Med. Jour., Jan., '96).
Pathology.—Chronic naso-pharyngitis may be divided pathologically into three varieties: the diffuse, hypertrophie, and sclerotic or atrophic. The diffuse form is present early in the disease, before the infiltration of cellular deposits has taken place; it is the transition period preced ing the chronic disease. In the hyper trophic form there is infiltration of the cellular elements, this stage culminating in sclerosis,—the third form,—in which atrophy and loss of function occur.
Prognosis.—The disease is controllable by appropriate treatment if it is not of too-long standing. In the latter case, however, it is practically incurable. Pharyngitis sieca is a particularly obsti nate affection.
Treatment.—If any constitutional con dition exists, this must first be appropri ately treated. Locally, cleanliness is the first essential and should be accomplished by some non-irritating alkaline, disin fectant solution, such as Seiler's or Dobell's. After the cavity has been cleansed, topical applications should be made to the post-nasal space as the con dition indicates. When dry, stimulants and alteratives such as nitrate of silver, 20 grains to the ounce, and iodine pig ment are to be applied. The following preparation is useful:— Iodine crystals, 6 to 10 grains. Iodide of potassium, 12 to 20 grains.
Glycerin, 1 ounce.—M.
This should be followed by the applica tion of some oily spray as albolene-and menthol solution, and be applied about every other day. If the naso-pharyngeal vault contains adenoid granulations, these should be curetted.
Attention drawn to the benefit which occurs from removal of septal spurs, ridges, and exostoses chronic naso pharyngitis. They are extremely com mon in this connection and should be removed with the saw. C. H. Knight (Laryngoscope, Apr., '97).
Tumors of the Naso-pharynx.
Neoplasms of the naso-pharynx may be divided into four varieties, namely: myxomata, fibromata, sarcomata, and car cinomata. The most common of these are the fibromata, the malignant variety rarely appearing.