As the term suggests, this disease is just the opposite from
hypertrophic rhinitis in that the membranes are shrunken, the nares
are wide open and usually the membranes are coated with a mucopurulent
discharge, accompanied by a bad odor. It is a chronic disease and
progressive in nature.
=Etiology.=—Deficient nutrition, systemic or local, or some
degenerative infective process constitutes the cause. Some cases may be
traced to syphilis, but this is certainly not always the cause. Chronic
sinuitis, the cause of which is some virulent infection, is often the
cause. Too much or incorrect surgery and cautery is certainly a cause
in many cases.
=Pathology.=—The marked atrophic appearance, the retracted
turbinates, the excessive purulent or mucopurulent foul discharge are
characteristic and diagnostic.
The tissues underlying the mucous membranes are shrunken, and atrophic
and this tissue has usually been replaced, sometimes almost completely,
by connective tissue, and thus the blood supply is markedly deficient.
=Treatment.=—In chronic cases, those in which the atrophy is well
progressed, there is no hope of restoration to normal conditions, but
I believe that the progress of practically every case can be stopped
and that, in most cases, a permanent cure can be effected under proper
treatment.
Every possible source of focal infection, such as sinuitis,
pharyngitis, tonsillitis, etc. should receive proper attention
promptly. After this has been done and sufficient time allowed for
normalization, a blood count may reveal some other source of focal or
general infection, which may be reducing the general resistance.
Auto-intoxication from some gastro-intestinal affection is commonly
a cause and must receive proper attention. The general health of the
patient must be restored and maintained.
Thorough osteopathic treatment must be given for any cause of lowered
nutrition, local or general. The failure, I believe, in medical
practice (They admit failure in this disease) is due to the lack of
attention to the restoration of normal nutrition. Why drain a sinus
and leave an atlas or upper thoracic lesion which decreases the local
nutrition and leaves these membranes susceptible to further infection?
Before and after surgical drainage, irrigation of the nasopharyngeal
tract. Thorough irrigation to cleanse every part. Hot irrigation (one
gallon of salt mixture solution, salt 3 parts, borax 2 parts, and soda
1 part, a tablespoonful to the gallon at 118°F. to 123°F.) to cleanse,
to free all parts from infection and to restore blood supply to the
affected parts. Frequent irrigation, daily for a sufficient time to
thoroughly sterilize and restore circulation. After each irrigation,
an oil spray (any non-irritating petroleum oil) is applied freely to
protect the membranes from irritation and further infection.
Before each irrigation a thorough probe treatment, as described under
hypertrophic rhinitis, should be given that the membranes may be
thoroughly freed from all retained secretions.
After the membranes are once clean, the sinuses free from infection
and the blood supply reestablished, the treatment may be reduced in
frequency to three times weekly, but the treatment must be continued
for months or even years to effect a permanent cure. The patient can
be taught to do his own irrigation after the disease is well under
control. All irritating sprays, chemical cauteries, etc. must be
avoided. The so-called “antiseptic sprays” do harm by irritating the
membranes and certainly do no good, because they do not cleanse the
parts. They only serve to deodorize, but actually accomplish nothing in
the way of cure. It has been my experience that iodine and the silver
salts in any of their various preparations are not efficient but that
they actually do harm. My experience indicates that practically every
case can be cured if the proper treatment is given for sufficient time.