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

48                  THE NOSE AND PARANASAL SINUSES

TREATMENT. The condition should never be treated by vasoconstrictor
drops or sprays which merely exaggerate the vasomotor imbalance. Ephedrine
hydrochloride may be given orally in doses of 15-30 mg thrice daily for its
sympatheticomimetic effect, but in the elderly it has the disadvantage of
tending to suppress urine. Pseudoephedrine hydrochloride (Sudafed) may be
used in doses of 60 mg thrice daily. Phenylpropanolamine hydrochloride
combined with mepyramine and pheniramine (Triominic) or triprolidine
hydrochloride with pseudoephedrine (Actifed) are useful decongestants when
taken by mouth. Tricyclic antidepressives, e.g. imipramine (B.P.) in doses of
25 mg thrice daily, may be used.

Care must be taken to explain the condition to the patient, and to make
him break the reliance on various intranasal medications to which he has
become addicted. This in itself can do much to help, but in certain severe
cases psychiatric assistance may be necessary to overcome deep personal
worries.

The swollen conchae may be shrunk by cautery or submucous diathermy,
while hypertrophic fringes may be reduced by a limited trimming of the
conchae and nasal polypi should be removed. In severe cases when conserva-
tive therapy has failed destruction of the nerve of the pterygoid canal via a
radical anstrostomy (Caldwell-Luc) or a transpalatal approach may give a
dramatic cure, but the operation is a major one.

RHINITIS MEDICAMENTOSA

This term is used to describe the iatrogenic disorder resulting from the
widespread overuse of nasal drops and sprays as mentioned above. The
overuse of snuff may also promote this condition. The sympatheticomimetic
drugs vary in the intensity and duration of their vasoconstriction, and
consequently in the subsequent vasodilatation. This results in further nasal
obstruction compelling the patient to resort to stronger vasoconstrictors so
that the frequency of their use increases progressively. Vasomotor rhinitis is
the condition which, pre-eminently, gives rise to this abuse, and is the
condition in which, above all others, nasal drops and sprays containing
sympatheticomimetic drugs should never be used. The only treatment for this
is to explain the condition to the patient, and to persuade him to stop the use
of these drugs. Treatment for vasomotor rhinorrhoea will help.

CEREBROSPINAL RHINORRHOEA

Cerebrospinal rhinorrhoea is not a common condition. As its name implies,
it consists of a leakage of cerebrospinal fluid into the nose. The most common
cause is a head injury resulting in a fracture of the anterior cranial fossa with a
tear in the dura mater, but it may also arise from a congenital defect in this
fossa, such as a leaking meningocele, or from erosion of the cribriform plate
of the ethmoid bone by prolonged increased intracranial pressure from a
tumour or hydrocephalus. There may be a cerebrospinal fluid leak following
trans-sphenoid hypophysectomy.

The fluid is clear and watery, and is more commonly unilateral. The amount
varies widely, and is increased by bending forwards or by straining, sneezing
or coughing, and the flow may be intermittent or continuous. When the