Very much depends upon the age of the patient. If the disorder is recognized in early life or at the time when the symptoms are most pronounced and fore local or systemic complications set in, operative interference arrests the course and duration of the malady. In a given case of a child or youth suffering from adenoid vegetations it is almost al ways safe to advise parents in the follow ing manner: 1. That complete removal of the growth restores nasal respiration.
2. That the tendency to take colds in the head, accompanied by sore throat or bronchial cough, will be lessened. 3. That reflex conditions will disappear. 4.
That snoring will diminish. 5. That mental and physical vigor will become increased. G. That chest-deformity will usually subside. 7. That impaired hear ing will be remedied. S. That restless ness during sleep will become modified. 9. That general malnutrition and anx mia will become improved.
On the other hand, in adults where serious ear disturbances—such as chronic otorrhcea, deafness, tinnitus aurinin— are the result of long-continued post nasal stenosis, a guarded prognosis must be given.
In cases of epilepsy or asthma directly traceable to the presence of naso-pharyn geal adenoid growths it always is the part of wisdom to promise but little from treatment, though one is forced to enter tain the belief that nasal obstruction is, in a great measure, connected with the origin of the paroxysm.
Treatment, — Cases are occasionally met with that do not present the usual clinical aspects of the malady. They show but slight embarrassment to nasal breathing during attacks of eoryza, a proneness toward sore throat and some enlargement of the faucial tonsils, and a moderate manifestation of nervous in volvement. Further than these evidences perhaps nothing more is present indicat ing the existence of the affection.
An immediate operation in these mild forms should not, as a rule, be insisted upon if opposition is offered parents and friends. The patient should be kept under observation, the behavior of the growths and the effect ealarrlial con ditions of the naso-pharyngeal cavity have upon them being closely watched. Change of cliinate or of environment often has a salutary effect ; complications are thus warded off. Should it, however, be ascertained that the vegetations have a tendency to develop, threatening ob and airect the mucosa of the neighboring organs. radical removal is inclioateil. Under practically- all eireum how ever. early and complete
reilioNal of the growth, is rational and absolutely justifiable when it is tit red that topical and internal applica tion, of remedies have little or no effect.
the indkatiuns tu removal of adenoid vegetations are liremophina, anoinalie• of the arteries in the naso pharynx. and during family epidemics of whooping-rough. measles. or influenza.
an ;tone or subacute eatarrhal condition of t lie respiratory passages is present. NI. Helm (Soc.
(1.0tol., (le Laryn.. et de Rhin.; Nled. Jour., June. '00 I .
Of 2019 eases of adenoid growths treated in La Clinique des Enfants Alalade-, 1214 were of the respiratory type, 75 of the auricular type. and 730 of mixed form. Prophylactic treatment should be instituted in those cases which present predisposition to lymphatic en largements, and it should consist of gen eral tonics and local antisepsis. among the latter being instillations of oil and insuffiations of medicated powders. :Mentholated oil (1 to 50) is preferred. but, in eases where this is not well tol erated, a combination of sterilized olive oil with resorein (1 part to 23 of the oil) is of value. The instillation should be made two or three times a day. Borate(' vaselin or mentholated vaselin may be used instead. An excellent powder consists of menthol, 10 centi grammes (1 '/, grains); boric acid and talc, of each, 5 grammes (11/4 drachms). The nasal irrigation may be prescribed with the above treatment, but the possi bility of damage by this method is noted. It is necessary to have the Nina! freely open and use but slight force in the douching. In using the douche the quantity should not be more than °O cubic centimetres (5 flitidrachins); the fluid, preferably a boric acid solution. When the adenoids are actually present, medieal treatment should consist of an application of iodine with glyeerin, I to 50; but this is merely palliative. and hurgiva I measures are the citify means to effect a ein.e. clivittier (Annales de MM. el; air. Infantiles, Jan. 1, 1901). Certain constitutional conditions some times exist indicating the use of cod liver-oil or some other form of the so called reconstructives. Tile tuberculous or scrofulous diathesis is the condition chiefly requiring such assistance. After the occlusion of the naso-pharynx has been overcome these cases seldom re quire internal medication, as the im proved respiration soon revives the powers of nutrition and gives renewed vigor to the individual.