Subatrophic, trophic rhinitis and related pathologies

Subatrophic, trophic rhinitis and related pathologies

Many incorrectly used terminology to denote a certain painful form - "runny nose", "dry runny nose", "chronic rhinitis" - for a specialist serves only as confirmation of a superficial and insufficient acquaintance with this area. She had the right to exist only in the old days when knowledge of rhinology was still very limited.

Now we should talk about the symptom complex, which is observed in certain and various painful conditions. The main symptom of a "dry runny nose" is a feeling of dryness and nasal congestion, when the patient cannot breathe through his nose for a long time, complains of headache, feeling of heaviness, shortness of breath, loss of smell, etc. Such a state may occur only from time to time: when the temperature changes (from frost to a warm room), after eating or at night in bed (the side on which the patient lies is laid), "at the slightest cold", according to the patient, or regularly in summer.

The doctor, squeezing alternately one or the other nostril, determines the force of the exhaled air stream, which makes it possible to judge the degree of nasal blockage (with the help of a substituted finger, a mirror, or polished metal surface).

The so-called dry rhinitis differs from acute rhinitis in the absence or extremely negligible discharge from the nose. What is the cause of "dry rhinitis"? Its etiology is unknown, and this concept is outdated. These can be curvatures and protrusions of the nasal septum, diffuse or limited thickening of the nasal mucosa, as well as diseases that cause hypertrophy of the nasal mucosa. Sometimes a slight cauterization, removal of the hypertrophic part of the nasal mucosa, treatment is sufficient to relieve the patient of the painful sensations caused by a "dry rhinitis".

The next common cause of nasal obstruction is nasal polyps. In adults, less often, and in children, almost always the more distant cause of "blocking rhinitis" lies not in the nose, but in the nasopharyngeal region. Adenoid enlargements obscure the choanas and cause those disorders in the child's nasal breathing, which others take for innocent rhinitis and do not attach due importance to them. Meanwhile, they can bring irreparable harm to the child's body.

Nasal breathing can be difficult for benign and malignant tumors. Note that malignant neoplasm, also, is manifested by inflammation in the circumference of the nose and the involvement of adjacent areas of the bone (they seem to be swollen), cerebral and neurological symptoms, nosebleeds, the cause of which is not associated with changes in the anterior part of the nasal septum.

Difficulty nasal breathing, especially, on the one hand, foreign bodies and rhinolitis, also, obstruction is caused by congenital or acquired, complete or incomplete choanal atresia.

Finally, the picture of a "runny nose" can be created by painful conditions, the delay in recognition of which is extremely important. These are bone processes of tuberculous and syphilitic etiology, occurring inside the nose with infiltration, ulceration, and sequestration. Often, such severe forms of the disease of the nasal skeleton are not accompanied by severe symptoms. Only more or less severe swelling weighs on the patient, who patiently endures them, mistaking them for "runny nose", and does not attach any importance to them. The process progresses and leads to significant destruction inside the nose, disfigurement of the external nose, while timely recognition and treatment of these conditions could save the patient from serious consequences.

This applies especially to syphilis. As you know, the bones of the nasal skeleton are a favorite place for gummy processes. It is clear that a long period passes between the appearance of fresh rashes and gumma, that the initial phenomena of infiltration in the nose are usually insignificant, therefore neither the patient nor the doctor often thinks about their connection with the once transferred infection, adhering to the diagnosis of "runny nose" and missing an important moment for initiation of general and local treatment. On the other hand, many doctors neglect local treatment for existing syphilitic processes (papular or gummy) in the upper respiratory tract, since they observed a cure even if only general therapy was carried out. This view is a gross mistake.

Disorders caused by syphilitic processes in the pharynx and larynx at the stage of rash and destruction, which are a consequence of gummy processes, need not only general but also local treatment. Then the patients would not suffer for months from excruciating pains during swallowing caused by papules in the pharyngeal region, they would avoid hoarseness, voicelessness (a consequence of papular and inflammatory changes in the larynx), severe destruction of the mucous membrane, cartilage and bone in the nasal region, which are eliminated after long years of general treatment, leaving large defects and scarring.

The same is the case with tuberculous diseases. For example, according to previously obtained data, salvarsan was a quick and potent agent, but even with its use, local treatment cannot be dispensed with. Differentiating syphilis from tuberculosis is possible only after prolonged examination and observation using various auxiliary methods (for example, RW, bacteriological and histological studies of pieces of the obtained tissue), however, in practice, some characteristic signs can help. So, with tuberculosis, the process usually proceeds torpidly, inflammation in the surrounding tissue is absent or expressed to a weak degree.

With syphilis, the surrounding tissue, even the outer part of the nose, its back, is involved in the process, which is accompanied by swelling and redness. While tuberculosis is localized only in the cartilaginous part, i.e. in the anterior part of the nasal septum, for late syphilitic forms, localization in the bone tissue is preferable, i.e. at the back of the nasal septum. With tuberculosis, there is never spontaneous pain or pain with pressure, with gummy syphilis of the nose, there is a constant headache, neuralgia, pain is noted when pressure is applied to the bony part of the nose. Pus secreted from the nose with tuberculosis is often odorless, with syphilis - with a putrid odor.