Hypertrophic rhinitis is one of the most frequent of the diseased
conditions pertaining to the nasal cavities that we are called upon to
treat, and the question of the most suitable method of treatment is to
be decided with care.
We have all used, for the removal of the excess of tissue, perhaps, with
more or less success, the acids, the actual cautery, or some form of
cutting instrument, but the patient, at least, will welcome a method
that promises a good result with the least amount of pain at the time of
treatment, and the least soreness afterward.
I have found that the application of the galvanic current does, in many
cases, furnish just the method desired, and I shall beg your attention
for a few minutes while I speak of the method as I practice it.
I shall not burden you with my ideas of what cause most enters into the
production of these nasal hypertrophies, leaving to you the perusal of
the text-books that will give all the knowledge extant upon the subject.
We do find an increase of the nutritive forces, and our treatment must
be directed to a lessening of the blood supply in some way. Of course
where there is a local source of irritation, that must be removed at
once. If it is a deflected septum that is causing an irritation by
contact with the opposite side, suitable means must be adopted for its
repair before attempting to treat the hypertrophies opposing the
irregularities of the septum.
The hypertrophies that I shall speak of as being most amenable to
treatment by means of the aid suggested in my title are mainly those of
the turbinated bodies: and, of these, the inferior is the one most often
enlarged. It may be confined to either extremity, or the whole body may
be the subject of hypertrophy. When, as is sometimes the case, the bony
portion of the turbinate has become enlarged, the saw, and not
electricity, will be the best means of cure.
But when the occlusion of the nares is caused by true increase of tissue
we have, in galvanic electricity, a potent agent to safely and rapidly
remove the obstruction.
To prepare a case for treatment, I always first thoroughly irrigate the
nasal cavities with some antiseptic fluid, using the post-nasal syringe.
The solution that I most frequently use is Electrozone one part, and
tepid water four parts. Then an application of a four per cent. solution
of cocaine is made to the location about to be treated, simply to
prevent the little pain which accompanies the introduction of the
electrode.
The electrode I use is a slender needle about the size of an ordinary
darning needle, of suitable length for easy use on the part selected,
and I insulate it by dipping it in shellac and laying it away until it
is perfectly dry, then scraping away the insulation as far from the
point as it is calculated it will be impaled into the tissues. It is
fastened into an ordinary needle-holder and connected with the negative
pole of the battery, when it is introduced into the tissue at the point
selected. The patient is then given the sponge electrode connected with
the positive pole of the battery and is told to grasp it firmly, and the
current is slowly turned on until the meter registers from three to five
ma., which current is allowed to remain stationary for about five
minutes, unless the patient is very nervous, when three minutes should
be the limit.
The current is now turned off as gradually as it was turned on and the
needle carefully removed. I do not attempt a second treatment at the
same point until a week has expired, and in some cases two weeks can be
permitted to go by before the shrinkage due to the electrolysis has
subsided. The stronger currents have been tried, but the strength I have
used and given here acts much more pleasantly and gives equally good
results.
During the summer just past I had the opportunity of noticing the
reduction of an enormously hypertrophied inferior turbinate in a most
unexpected manner, which I am glad to relate at this time.
A lady of about fifty years of age, who was stopping at the hotel at
which my family and myself were located, came to me one day to ask my
opinion as to her eye and nose. She had had a stricture of the nasal
duct for a number of years, which had been duly dilated several times,
and for a considerable time had had a dacryocystitis which annoyed her
greatly, and from which she was able to press a large amount of mucus
and pus from the canaliculus.
The inferior turbinate on the affected side was hypertrophied for nearly
its whole length and was in contact with the septum for some distance at
the anterior extremity, being of a deep red color and very sensitive to
touch. I told her that I believed it would be necessary to remove the
turbinate with the saw and advised its removal as soon as possible,
giving it as my opinion that it would be necessary to do the operation
before the condition of the eye could be relieved. The patient admitted
the force of my argument, but was inclined to wait a while until she
could get her courage up a little higher. Meanwhile she wanted the canal
dilated and begged me to do it. Visiting New York, I supplied myself
with a canaliculus syringe and a set of Bowman’s probes, and on my
return announced myself ready to commence treatment. I proceeded to
insulate the probes in the manner alluded to for needles in nasal work,
scraping the points bright for about a quarter of an inch.
Before introducing the probe I washed the sac out thoroughly with a
fifty per cent. solution of enzymol, and then, connecting the probe
electrode with the negative cord of a galvanic battery by means of an
artery forceps, introduced it (No. 2,—a No. 1 would not pass in the
ordinary manner with considerable pressure) into the canal, and turned
on the current until the meter registered two milliamperes. Using just
enough pressure to guide the electrode, it gradually found its way along
the canal, and in less than five minutes it had entered the nasal cavity
without causing the loss of a drop of blood. In three days I passed a
No. 4 in the same manner, and four days later a No. 6 passed easily.
Three days after this a No. 7 was passed, and that size was passed three
or four times afterwards at intervals three or four days. After the
first passage of the No. 7, all of the solution used for the purpose of
cleansing the sac passed through into the nasal cavity directly from the
syringe, and there was no further collection of pus in the sac during a
week in which the syringe was not used.
The point I wanted to bring out, however, is that after the second
treatment by electricity, the color of the mucous membrane covering the
turbinate began to grow paler, and at the end of the treatments the
entire body had contracted sufficiently to permit free and easy drainage
and natural respiration.
I am led, by this, to the thought that it may be good treatment in many
cases of hypertrophy of the inferior turbinate, and possibly the others
as well, to use the insulated probe electrodes in the lachrymal canal
with the weak current, not exceeding one or two milliamperes. The
careful use of this method may prove it to be a valuable addition to the
present means of treating a class of cases that are troublesome to the
patient and the doctor.