Diseases Of The Nose Throat And Ear

44 THE NOSE AND PARANASAL SINUSES

grasses, usually the Timothy grass which pollinates in this country from May
to July, being rather later in starting the further north one lives. In recent
years daily pollen counts have been included in weather forecasts, the count
being higher in hot still weather. The severity of hay fever thus varies from
year to year, depending upon the weather. Those who are sensitive to proteins
which are met with all the year round, like house dust, cosmetics, animal
emanations, etc. have less violent perennial symptoms with acute exacerba-
tions from time to time. Children have the habit of rubbing their itchy allergic
nose with the palm of the hand, and may even cause a transverse fold or
wrinkle to develop on it.

CLINICAL FEATURES. It is most important to take a detaile^gerspnal and
family history, including particulars of the dajlyJife-and habits of thej^atient.
One must not only diagnose the condition, but should attempt to pinpoint the
allergen. Many patients have a knowledge of their condition and have tried to
discover the cause for themselves, so that their history may be extremely
helpful. In those patients whose symptoms are of relatively short duration it
may be possible to establish certain altered circumstances of life about the
time of the onset, getting married, becoming pregnant, moving house,
acquiring a garden or changing gardens, changing occupation, altering habits
with regard to cosmetic preparations, bed covers, etc.

Anterior rhinoscopy in the acute phase will shqw_ pallor and oedema of the
mucous membrane of the inferiqrjxmcha which may be so swollen.as~Icnead
the inexperienced to mistake it for a nasal polypus. There may Hbe watery _
nasal secretion in excessive amount in the nose The conjunctivae are con-
gested.. During remissions in hay fever subjects, who are often symptom-free
from August to April, the nasal mucous membrane may appear healthy. The
perennial sufferer will show oedematous mucous membrane in the nose,
usually pale grey^ but sometimes reddish with a blue tinge, and this mucosa
shrinkslapjglyj>iijhe_jipjgjjcation "oFa^plejdget of cotton-wool^soakeSTm"""
10 per cent cocainejixdrochloride solution. These patients also have an
increase of mucoid secretion in the nose. It is not uncommon to see ajanall
oedeniatous rajseB mound on the floor_of the noseat the level of the anterior
end, of^j^lnferi^r^con^ajjQ allergic subjects, whether they be children or
adults, ancf this may~6e seen even during remission of symptoms. Th&jiose
may or may not conta2n_o^ejox.?Ilor€Lnasal polypijof varying size.

Radiography "oflhe paranasal sinuses may be negative, but often shows
some thickening of the mucosal lining, comparable to the nasal oedema,
while occasionally, more often in children, there is a solitary polypoid

opacity in the floor of the maxillary sinus. " ~~~-------•~

An increase in the number of eosinQBhiis may be found in the peripheral
blood, and a swab 6? nasal secretions may reveal the presence "oFlhany
edgmophils.

Skin Jesting is done to determine the group of allergens, or even the
particular allergen, to which the patient is sensitive. There are two methods of
testing: the mtradermal injection, and the scratch or prjcktest. The former is
the more sensitive test but it may give rise to severe reacHoiosT In thejprick test
a positive reaction is an area of congestion and a weal appearing on the spot
on ttefofKuttTfifc^^ for testing

a number "of allergen groups aTtTiesameTime. Those groups showing positive
responses are noted and at a later test the constituent members of the group