=Etiology.=—Chronic rhinitis is usually a result of an infective
rhinitis and has for its cause any one or more of the various causes
given above under purulent rhinitis.
=Pathology.=—The pathology in chronic rhinitis varies with the cause,
but is usually characterized by a series of changes beginning with
infection and hyperemia and followed by an actual and usually marked
hypertrophy of the interstitial tissue. The posterior ends of the
inferior or, less often, the middle turbinates are usually enlarged and
extend backward into the pharynx.
=The Symptoms= are much the same as in purulent rhinitis, except that
the purulent discharge is often not present. These cases usually suffer
from chronic head colds, headaches and persistent nasal obstruction.
The senses of smell and taste are usually impaired and there is a nasal
twang to the voice.
=Treatment.=—In these cases, it is common to find osteopathic causes
which prevent proper drainage from the head and neck and this is
important because, if all the local causes are properly corrected, this
is not sufficient to effect a cure.
Surgical treatment for the removal of polyps, synechia, adenoids,
adhesions, correction of septum, or hypertrophied or cellular middle
turbinates is often essential and certainly infected sinuses must be
properly drained. We have had cases in which root abscesses seemed to
be active causes, but it must not be thought that surgery and surgery
alone is likely to cure chronic rhinitis, and I want to caution against
the wholesale removal of turbinates for such conditions. The mere fact
that the turbinates are enlarged is not sufficient reason for their
removal. There has been a cause for this enlargement and turbinotomy or
turbinectomy does not remove this cause. Cautery is worse, because it
seldom accomplishes more than very temporary results and often leaves
the membranes worse than before. Cautery destroys mucous membrane,
leaving a dry and easily irritated surface which is often impossible to
normalize.
The proper surgery, carefully done, followed by efficient osteopathic
corrective work and thorough irrigation of the nasopharyngeal tract
with the necessary oil spray protection after irrigation, will
constitute efficient treatment. Treatment, thorough and long continued,
will in due time restore nutrition, drainage and normal reflex nerve
control to the tissues. Treatment after surgery is essential.
=Intranasal Treatment.=—Many cases are caused by the retention of
secretions under the turbinates and in the superior vault. In all
cases, therefore, it is essential to thoroughly free all possible
retention cavities by means of a small cotton-wound probe before
irrigation. The intranasal membranes are adrenalized and anesthetized
and a thorough examination is made using a good reflecting lamp, nasal
speculum and cotton tipped probe. Every part of the intranasal region
is inspected for sources of purulent discharge, mucus collections,
synechia and for hypersensitive areas. The probe is curved at the
end and passed under each turbinate and drawn forward and backward
with considerable pressure to insure that any collection of foreign
matter is thoroughly removed. Every part of the intranasal region
should be thoroughly treated in this way. The hiatus semilunaris must
be kept well open to permit free antrum drainage and all other sinus
openings should be kept free from any obstruction that may block the
drainage. This particular technic requires great care and practice,
but it is very effective and so commonly we have found that this work
thoroughly done will reduce much and in some cases all of the turbinate
hypertrophy rendering surgery unnecessary.