RHINITIS.
The treatment of acute and chronic inflammation of the membrane lining the nasal passages will be found discussed in the articles on Catarrh and Hay Fever.
Hypertrophic rhinitis in its recurring form is seen in hay fever, where the various methods of treatment will be found detailed. Its typically chronic and persistent form may be regarded as the sequel to chronic nasal catarrh, and hence the treatment of hypertrophic rhinitis and of this affection is identical.
When cleansing of the nose and naso-pharynx, the removal of adenoids and the continual use of the alkaline Borax solution sniffed up several times daily fail, the case should be met by operation.
The simplest operative procedure is to apply cocaine and reduce the inferior turbinate bone by pencilling it with the galvano-cautery heated to a dull red, which should be drawn in a horizontal direction over the anterior surface. The operation should be repeated in about a fortnight, when the posterior end may be similarly scarred, each bone being dealt with at a separate sitting.
Should the thickening of the membrane not show signs of shrinking after a couple of operations, a series of deep punctures may be made into the mucosa by a sharp-pointed galvano cautery. After cauterisation a piece of Boric Acid ointment should be inserted upon cotton-wool. This method is better and safer than the application of strong caustics like Chromic or Nitric Acids, which are liable to be followed by adhesions between the bone and septum.
When there is narrowing of the air-way, a more radical procedure is necessary. The anterior end of the inferior turbinate bone should be removed after cocainisation by cutting through its attachment by scissors, punch forceps or a strong steel wire snare; after which the nostril should be plugged for a few hours to restrain any hxmorrhage and the nasal douche used regularly.
The posterior end of the bone may likewise be removed by snaring; after the introduction of the loop through the nose the snare is guided into position by the finger introduced through the mouth and the mucous and osseous tissue slowly divided to minimise haemorrhage.
In very aggravated cases with much narrowing the entire inferior turbinate should be removed by the spokeshave or ringed knife, or it may be snipped away piecemeal by the snare, scissors or punch forceps applied at intervals.
The treatment of syphilitic rhinitis known as " snuffles " in the con genital disease must be carried out by Mercury or Salvarsan administered internally. In the type of syphilitic rhinitis occurring in later years diseased bone is usually present which must be removed and the local measures described under Ozxna should be persistently employed.
Diphtheritic rhinitis calls for the serum therapy suitable to the primary affection, whilst the local condition calls for free douching with antiseptic solutions.
Dry rhinitis (Rhinitis sicca) corresponds to the type of a dry bronchial catarrh. The treatment is that of atrophic rhinitis, since the most con stant feature in the affection is the formation of dry crusts. These must be removed by syringing with a weak alkaline borax lotion, after which the introduction of a small portion of Diluted Citrine Ointment (made with lanolin) two or three times a day is the best routine. Any gouty tendency, glycosuria or alcoholic habit will require attention.
The treatment of Atrophic Rhinitis is fully detailed in the article on Ozmna.