CHRONIC RHINITIS Chronic rhinitis is characterized, anatomically and pathologically, by a marked cushion-like swelling and redness of the mucous membrane, most commonly seen in the region of the inferior turbinated bone with considerable enlargement of the venous network. A genuine hyper plasia of the tissue is less frequently present than one would expect from the great thickening. in prolonged cases, single portions of the mucous membrane may undergo atrophy.
rhinitis often develops from frequent recur rences of acute catarrhs, or it may develop gradually from the begin ning. Occasionally it is found in connection with acute infectious diseases, especially after measles, and in Isolated cases as the result of foreign bodies. The majority of cases are dependent upon a scrofulous condition, and are frequently associated with prexiously existing ca tarrhal conditions of tile mucous membrane, eczema, and chronic glan dular enlargements. \Vith exceptional frequency, chronic rhinitis develops either concomitantly with, or as the result of, a hyperplasia of the lymphatic tissue of the pharyngeal ring. The disease is regularly found in connection with hereditary- syphilis, these infants manifesting the well known symptoms of sneezing and snuffling. Later, in the course of the disease, there are added destructive ulcerations of the mucous membrane and the bony framework of the nose, leading to the well known and dreaded saddle nose. Uncleanliness and unsanitary habitations contribute largely to the production of chronic rhinitis and to the prevention of its cure.
increased secretion with its sequoia-, is first in the line of symptoms in chronic rhinitis. The discharge is mucopurulent, often greenish in color, rarely slightly bloody, and not offensive. It contains bacteria, the strepto- and staphylococci predominating. The nose is constantly surcharged with mucus, and often requires several handkerchiefs daily to keep clean. The liquid secretion usually gathers in the lower nasal passage, while further above dried crusts are found. In addition, there is a copious discharge of secretion from the nose, causing swelling and excoriation of the nasal entrance and of the upper
lip. The skin in the neighborhood of the nose often becomes eczema tous. The secretion also flows backwards through the posterior nares into the pharynx, causing frequent desire to clear the throat, attacks of choking, swallowing and a teasing cough which often disturbs sleep. The increased difficulty of breathing through the nose causes the in fants to keep the mouth open especially, at night, and to snore during sleep. At night, the breathing is noisy when the mouth is kept closed. Pavor nocturnus is a frequent result. Changes for the worse and im provement frequently alternate. The colder season of the year with the injurious atmosphere of the room regularly increases the trouble, as well as intereurrent infectious diseases. It is often difficult to decide to what extent chronic rhinitis participates in the obstruction of the nose, on the one hand, and how much may be attributed, on the other hand, to frequently coexisting adenoid growths in the nasopharyngeal space. The adenoids are usually of greater moment.
The frequent mouth-breathing often produces catarrh of the phar ynx and lungs. The insufficient pulmonary aeration leads to imperfect development of the chest (flatne,$): and an insufficient blood forma tion, frontal pressure, vertigo, migraine, and asthma are conditions often found in connection with chronic rhinitis. The voice acquires a nasal intonation. As complications, catarrhal ancl purulent otitis me dia and chronic conjunctivitis are first in importance. The diseased con ditions of the accessory cavities, which play such an important role in the chronic rhinitis of adults, need not at all be considered in young children during the first, years of life, because these cavities are very small and do not begin to participate until towards puberty. Abscesses of the antrum of Highmore, which perhaps may sometimes occur in younger children, are usually extensions of tuberculous processes from the alveolar process.