The prognosis is fairly good. The simple and the hypertrophic rhinitis are almost always amenable to treatment, although transitions to the atrophic form (oztena) may also occur. A rhinitis existing for years is detrimental to hearing anti respiratory organs, and injures the development of the thorax and the facial skull.
The prophylaxis consists in building up the constitution, the com bating of scrofulosis, and a general hygiene of the respiratory organs (described more explicitly under bronchitis).
growths coexisting with rhinitis are to be removed by operative measures. Nasal breathing being again rendered possible, the rhinitis is often cured in a short time without further treat ment. Of great importance is the systematic removal of large accumu lations of secretion. This purpose is served in the first place by a judicious method of bleming the nose, The usual custom of pressing shut both aloe nasi, simultaneously, causes an injurious increase of pressure and stasis in the nose. If an atterupt is made to have a child blow its nose in this manner, an uncom mon dexterity is required on both sides in order to have the expulsion of secretion and the release of the alm nasi occur simultaneously. The best method of bloning the nose is the one-sided one (like that of the working class, but with the use of the handkerchief). It is the only method which inay be permitted in "the blowing of the nose" in young infants by a third person. The whole current of air is concentrated in the one half of the nose, and in this way expells the secretion much better. All injurious results from increased pressure are avoided, as well as the danger of forcing the secretion into the tubes.
A cure of rhinitis is often better and easier obtainable by attention to the general health, than by the use of local measures. Attention to cleanliness, suitable indoor climate, plenty of out-door life, suitable clothing, judicious hardening, and the avoidance of coddling, on the one hand, together nith the provision of sufficient clothing, on the other, are to be taken into consideration.
In the many cases of chronic catarrh resulting from scrofulosis, the use of iron, iodide of iron and malt preparations, and codliver oil during the winter, will give good results. Strikingly beneficial are systematic hydrotherapy with the use of sea-salt or brine, residence at the sea shore, or in forest regions and in the mountains.
As regards local treatment, the use of douches and injections had better be avoided, since they are usually met by considerable resist ance on the part of children, and may lead to grave aural suppurations. For the last reason, also, the use of the Politzer air-douche for the purpose of removing secretions is inadvisable. Frequently, in chronic rhinitis, especially where the secretion is plentiful. good effects are ob tained by evaporation of an ethereal oil in the vicinity of the patient.
For this purpose, 1-2 teaspoonfuls of the oil of turpentine are poured on a piece of pasteboard anci placed near the head of the bed every night.
In older children, from five to seven years of age, irrigations of the nose with a lukewarm normal salt solution are advantageous, or when the secretion is tough, with sodium chloride, sodium bicarbonate, and sodium biborate, of each a knife's point-full to one glassful of water. The
flushing is done by pouring the solution into the nose with a pointed teaspoon, the head resting slightly backwards. The solution runs through the lower nasal passage into the pharynx and is expectorated with the mucus which is carried with it. For the purpose of cleansing the nose, one can also use long tightly twisted pieces of cotton which are rished horizontally backwards to the posterior nares.
instillations into the nose of the oil of almonds with 1 per cent. of menthol, also a 3 per cent. aqueous solution of protargol, have often proved useful to me. 1-3 drops are instilled in each nostril several times. Insuffiation of powders is popular, though insoluble powders must be avoided. To be considered are borax or boric acid with perhaps the addition of 10 per cent. sodium sozoiodol. For older children, the daily introduction of tampons spread with boro-vaseline are recommended for cleansing and healing purposes. in stubborn cases of rhinitis in older children the direct application of boro-vaseline often acts very benefi cially (Boulay). The child introduces with the index finger into the vestibule of the nose a quantity of boro-vaseline (10-20 per cent.) about the size of a hazel-nut; the other nostril is then held shut and the boro vaseline is snuffed up with the head bent backwards. It soon melts and lines the nasal cavity, producing a free discharge and softening the dried secretion. The other nostril is also attended to, at once. After 5-10 minutes the child should blow its nose, expelling the ointment and nasal secretions thoroughly. Good effects are often obtained in severe and obstinate cases of hyperplasia of the cushion of the mucous mem brane by a 2-5 per cent. solution of nitrate of silver applied daily or every other day by the physician himself, the parts having been previously cleansed. Stoerk recommends the introduction of cotton tampons moistened with a 1-2 per cent. solution of nitrate of silver once or twice daily for several minutes. Highly hypertrophic portions of the mucous membrane are suitable for galvano-cautery treatment by the specialist. The often present eczema of the nasal orifices and vestibule of the nose is made to disappear by the application of 1-3 per cent. ointment of white precipitate ointment with the addition of lanolin, the crusts having been removed.
Chronic atrophic rhinitis demands treatment of the existing anfemia and scrofulosis. Locally, the frequent removal of the driecl crusts is necessary. For this purpose, nasal douches carefully used and under the control of the physician, are permissible (normal salt solution, sodium bicarbonate, 1 per cent. or thymol 1 : 10,000). The physician may also frequently remove the crusts with forceps or probe. In ozama, especially, the treatment nith boro-vaseline as described above, is said to be useful.
In obstinate cases, the crusts are loosened by the application of Gottstein's temporary tampon. Firmly rolled cotton tampons, dry or saturated with a 3 per cent. solution of peroxide of hydrogen, are intro duced for to hour. They stimulate the secretion and carry the crusts with them. Insufflation of iodol on the cleansed mucous membrane is advocated by some.