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Full text of "Diseases Of The Nose Throat And Ear"

46                   THE NOSE AND PARANASAL SINUSES

this covers the hay fever season. Weekly injections of 0-5 mgpf tetracosactrin
zineXCortrosyn Depot or Synacthen Cepot) are effective"and do not depress
pituitary-adrenal function.

Desensitization may be carried out if skin testing shows a limited spread of
sensitivity. It is less successful in patients who react to several groups of
allergens. Injections are given weekly in increasing doses for 6-8 weeks and
thereafter a boostefjlbse may be" given annually. As witn other vaccine
therapy, anaphylactic shock may developr~scfthat adrenaline should be at
hand to counteract this. There are standard vaccines on the market to control
the more commonly found allergens, pollens and house dust. Hay fever
subjects are given Alavac-P, Allpyral-G or Pollinex, while perennial allergy
may be treated by Alavac-D, Allpyral mite-fortified house dust or Migen.
Specific vaccines may be prepared from the results of skin testing and are
prescribed as Alavac-S, Allpyral Specific or S.D.V., and are given for 18
weeks. Children are especially liable to anaphylactic reactions, and special
precautions must be taken before a course of vaccine therapy is prescribed for
them.

The size of the oedematous inferior concha may bej^duced by shrinking
the concha, undeTTloc'ar or general anaesthesia, by drawing the electric
cautery along its length to produce two or three linear scars. This fias been
criticlzecTHecause of the destruction of the^ufface"epithelium, and a satis-
factory reduction in size may be obtained by submucous diathermy in which
similar Ijnea^buros^re made hi the submucosa along the length of the concha.

Nasal surgery should be minimaFIn allergic "subjects, bttt-s^bmucous
resection of the nasal septum, removal of nasal polypi, or trimming of
grossly hypertrophic fringes of the inferior conchae may be indicated on
general grounds, as there is little point in controlling the allergy and leaving
the nose obstructed from mechanical causes. Surgery of the sinuses should
also be minimal. Some patients may produce an asthmatic attack following
nasar oTsirius surgery, and this may be averted by operating under a cover of
corticosteroids.

Removal of tonsils and adenoidsjn children has no effect on nasal allergy.
Parents^6rfd~to~believe that^his operation will cure any nasal obstruction and
are greatly disappointed when it does not. If removal of tonsils and adenoids is
indicated in a child who is found to have the pale oedematous nasal mucosa of
allergy, the parents should be specifically warned not to expect relief from the
underlying allergy, although removal of adenoids may play a considerable
part in the mechanical relief of the airway. The treatment of nasal allergy in
children is often made more difficult because there is frequently a coexisting
low-grade infection of the nasal lining, and it is difficult to cure both the
infective and allergic elements.

VASOMOTOR RHINORRHOEA

In order to understand vasomotor rhinorrhoea, or vasomotor rhinitis, or
vasomotor imbalance, it is necessary to consider the various factors which
affect the engorgement or otherwise of the submucosal vascular system in the
conchae. The vasomotor nerve supply derives from the parasympathetic and
sympathetic systems which join in the nerve of the pterygoid canal (Vidian's
nerve) and run to the pterygopalatine ganglion. Here the parasympathetic