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

CHAPTER 28
DISEASES OF THE NASOPHARYNX

ACUTE NASOPHARYNGITIS

Acute inflammation may extend from the nose or pharynx to involve the
nasopharynx. In addition, one may recognize an acute inflammation, confined
to the lymphoid tissue of the nasopharynx, which resembles an acute tonsillitis.
In such cases the pharyngeal tonsil is covered with mucopus and this may be
the cause of obscure feverish episodes in children. It is often accompanied by
enlargement of the cervical lymph nodes, and there is a complaint of dis-
comfort in the back of the nose, nasal obstruction and pain on swallowing.
Examination of the pharynx may be negative but posterior rhinoscopy will
show the adenoiditis. Treatment, in so far as this is applicable, is that for
acute rhinitis. In severe cases a broad-spectrum antibiotic is prescribed, but in
less severe cases an antibiotic nasal spray with a decongestant should
suffice.

CHRONIC NASOPHARYNGITIS

AETIOLOGY. Chronic inflammation may extend from the nose or pharynx, and
chronic rhinitis, chronic sinusitis or chronic pharyngitis may produce
chronic postnasal catarrh. It is common in smokers, heavy drinkers and in
those exposed to dust or irritating fumes.

SYMPTOMS. The chief symptom is the feeling of some accumulation at the
back of the nose giving rise to a constant desire to clear the throat by hawking
followed by the expectoration of viscid secretion. The subjective disturbances
vary greatly in different individuals and are unrelated to the extent of the
objective changes.

CLINICAL FEATURES. There may be merely congestion of the mucosa of the
nose, pharynx and nasopharynx or there may be hypertrophy of the mucosa
with small lymphoid aggregations. In the nasopharynx these changes are seen
in the vault where there may be tenacious mucus or mucopus. A chronic
abscess in the remains of the median recess in the pharyngeal tonsil is called
Tornwaldt's bursitis.

TREATMENT. Infection in the paranasal sinuses or tonsils should be dealt
with, and any nasal obstruction should be corrected. The general health of the
patient must be regulated. The urine should be examined for sugar and
albumen; excessive smoking and drinking corrected; and overheated poorly
ventilated environments should be corrected. The use of nasal sprays such as
framycetin and gramicidin (Soframycin) or 1 per cent silver protein (Argotone)
are helpful.

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