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36 THE NOSE AND PARANASAL SINUSES
factories, etc. are fruitful sources of infection from droplets spread by
coughing, sneezing and even speaking. Overheated and overcrowded rooms
lead to the easy spread of infection, and fresh ajr_s.hQuldJbe allowed to
circulate widely. Resistance may be increased by a regularjmtake^tvitarnins,
especially vitamin _£L Polyvalent va^cines-agaiast the common cold have
proved successful in some patients if given in the late summer or early
autumn, by reducing the frequency and severity of attacks, but this is by no
means the general experience.
This is characterized by the formation of a false membrane on the nasal
mucosa, and is always associated with the presence of C. diphtheriae, but, in
keeping with the reduced incidence of faucial diphtheria, the disease is now
extremely rare in this country.
SYMPTOMS. The symptoms are those of nasal obstruction and discharge
which may be clear or mucopurulent, and is often combined with epistaxis.
There is little general upset. The condition is infectious, and may persist for
weeks if untreated.
CLINICAL FEATURES. The mucous membrane of the inferior and middle
conchae is covered with a greyish membrane which is rather difficult to
remove, and leaves a bleeding surface on which the membrane re-forms. The
membrane is indistinguishable from true diphtheria.
TREATMENT. The patient should be isolated until the nose is clinically and
bacteriologically clear, and a full course of penicillin should be given.
CHRONIC HYPERTROPHIC RHINITIS
This may result from repeated^c»te.attacks>_but it is predisposed to by certain
occupations involving dust^atmospfaeres or exposure^ to cheinical irritants,
ft may occur with a deflected, nasal septum or in patients -vi^^or^^saxos
infection, and in those who are excessive in the us^joJ^c^hpXoxlPiaccp.
SYMPTOMS. The main symptom is nasal_ pjbstrjicliQp, especially at night. If
the obstruction is marked there may be impaired serjse_QLsinell,.and^lastfi.
The nasal secretion may be either mucpid or viscid, and may be profuse in
CLINICAL FEATURES. The nasal mucosa is congested, and areas_pf hyper-
trophy are seen, particularly in the" anterior or posterior ends of the inferior
concha. There may be a hypertrophic fringe running along the entire length of
the inferior concha. The middle concha is less affected. The application of
cocaine hydrochloride (10 per cent) on a pledget of cotton-wool will serve to
distinguish true hypertrophy from vascular or allergic swellings which will
shrink markedly. Posterior rhinoscopy shows the hypertrophy of the posterior
ends of the inferior conchae as mulberry-like .swelliogs-^/tfte /, 3).
TREATMENT. This varies with the degree of discomfort and the amount of
hypertrophy. An early case mayjrespond to simple -decongestant sprays
containing ephedrine hydrochloride, 1 per cent in normal saline, but the
established hypertrophy may require surgical trirnming of the overgrown
fringe or the mulberried posterior ends of the inferior concha. There is a
danger in overzealous removal, which may produce a degree of atrophy.