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DISEASES OF OLFACTORY

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Originally appearing in Volume V20, Page 80 of the 1911 Encyclopedia Britannica.
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DISEASES OF OLFACTORY SYSTEM External Affections and Injuries of the Nose.—Acne rosacea is one of the most frequent nasal skin affections. In an early stage it consists of dilatation or congestion of the capillaries, and later of a hypertrophy of the sebaceous follicles. This may be accompanied by the formation of pustules. In an exaggerated stage the sebaceous glands become overgrown, forming large protuberant nodular masses over which the dilated capillaries are plainly visible. This condition is termed lipoma nasi (rhinophynia or hammer nose), though there is no increase in fatty tissue. Nasal acne occurs mainly in dyspeptics and tea drinkers, and the more advanced condition, lipoma nasi, chiefly in elderly men addicted to al- coholism. The treatment of acne is the removal of the dyspepsia with the local application of sulphur ointment or of a lotion of perchloride of mercury. Un- sightly capillaries may be destroyed by an application of the galvano-cautery or by electrolysis. Free dissection of the re- dundant tissue from around the nasal cartilages is necessary in lipoma nasi, skin being grafted on to the raw surface. The nasal bones are frequently fractured as the result of direct violence, as by a blow from a cricket ball or stick. The fracture is usually transverse, and may be communicated, leading to much deformity if left untreated. The treatment is the immediate reposition of the bony fragments. The old-standing cases where there is considerable depression Cerebral wiring the fragments may be resorted to. 'hemi- In numerous cases the subcutaneous sphere injection of paraffin may improve the shape of the organ. Deflection of the septum may also result from similar injuries, and lateral displacement may cause subsequent nasal obstruction and require the straightening of the septum. Lesions involving considerable loss of substance due to injury or to syphilitic or tuberculous disease have led to many methods being devised to supply the missing part. In the Indian method of rhinoplasty a flap is cut from the fore-head, to which it is left attached by a pedicle; the flap is then turned down-wards to cover the missing portion of the nose; when the parts have united, the pedicle is cut through. In the Italian operation devised by Tagliacotius (Tagliacozzi), a flap was taken from the patient's arm, the arm being kept fixed to the head until the flap has united. Diseases of the Interior of the Nose.—Epistaxis or bleeding of the nose may arise from many conditions. It is particularly common in young girls at the time of puberty, being a form of vicarious menstruation. It also occurs in cerebral congestion, heart disease, scurvy, haemo- phylia, or as a sign of local disease. The treatment will depend upon the cause. In patients with high arterial tension epistaxis may be of direct benefit. In other cases rest on the back may be tried, with the local application of tanno-gallic acid or hazelin or adrenalin, either in a spray or on absorbent cotton. If these should not stop the haemorrhage the nose must be plugged. In cases which arise from specific forms of ulceration, such as tuberculosis and syphilis, the area should be rendered anaesthetic by cocaine, the bleeding points found, and the vessels obliten ted by the electrocautery. Polypi in the nasal passages are also a frequent cause of epistaxis. Rhinitis, or inflammation of the mucous membrane of the nose, occurs both in acute and chronic forms. Of the acute he simple catarrhal form termed "coryza " forms the widely known cold in the head." The tendency of acute coryza to affect entire families, and to be communicable from one person to another, points to its infectious nature, though probably some predisposing condition of health is necessary for its development. It is considered proved that the symptoms are due to the presence and development of Mesencephalon Eye Globular process Prosencephalon IV Lateral nasal process Olfactory pit Mesial nasal process Globular process the two globular processes, the intervention of the olfactory pits between the mesial and lateral nasal processes, and the approximation of the maxillary and lateral nasal processes, which, how-ever, are separated by the oculo-nasal sulcus (from His). IV. Transverse section of head of embryo, showing the deepening of the olfactory pits and their relation to the hemisphere vesicles of the fore-brain. several distinct micro-organisms. Of these the most important is the micrococcus catarrhalis described by Martin Kirchner in 189o, but Friedlander's pneumo-bacillus has also been found. In ordinary cases of coryza, sneezing, congestion of the nasal mucous membrane and a profuse watery discharge usher in the attack, and the inflammation may extend to the pharynx, larynx and trachea, blocking of the Eustachian tube producing a temporary deafness. Later the discharge may become muco-purulent. One attack of coryza conveys no immunity from subsequent attacks, and some persons seem particularly susceptible. The treatment is directed towards increasing the action of the kidneys, skin and bowels, A brisk mercurial purgative is indicated, and salicin and aspirin are useful in many cases. Considerable relief may be obtained by washing out the nasal cavities several times a day with a warm lotion containing boric acid. Those who are unusually prone to catch cold should habituate themselves to an open air life by day and an open window by night, adenoids or enlarged tonsils should be removed, and the diet should be modified so as not to contain an excess of starchy foods. An acute croupous inflammation occasionally attacks the nasal mucous membrane when the Klebs-Lofffer bacillus is not present, but the nasal membrane often shares in true diphtheria, or it may be the only organ to be infected thereby. The diagnosis is of course bacteriological. As a result of frequent catarrhal attacks the nasal mucous membrane may become the seat of a chronic rhinitis in which the turbinals become swollen with oedema, and congested and finally thickened by increase in the fibrous tissue. There is an excessive muco-purulent discharge, and the patient is unable to breathe through the nose; deafness and adenoid vegetations may be the result. In the early stages the nasal cavity should be washed out night and morning with an alkaline lotion, such as bicarbonate of soda, or a caustic, such as chromic acid, should be used in swabbing over the affected part. The application of the galvano-cautery here is useful, but when the areas are much hypertrophied the hypertrophied portion of the inferior turbinals may have to be removed under cocaine. A special form of recurrent hypertrophic rhinitis is hay fever (q.v.). Rhinitis Sicca is a form of chronic rhinitis in which there is but little discharge, crusts or scabs which may be difficult to remove forming in the nasal cavities; the pharynx may be also affected. Atrophic rhinitis or ozaena usually attacks children and young adults, following on measles or scarlet fever. Crusts form, and favour the retention of the purulent discharge. The disease may extehd to the nasal sinuses and septic absorption take place. The treatment is to keep the nasal cavity clean by irrigation with solution of permanganate of potash or carbolic acid lotion, the nose then being wiped and smeared with lanolin or partially plugged with a tampon of cotton-wool, the process being repeated at frequent intervals, the general treatment being that for anaemia. Disease of the middle turbinated bone is also a cause of an offensive nasal discharge, and rhinitis occurring in infants gives rise to the obstructed respiration known as " the snuffles." Three forms of nasal polypi are described, the mucous, the fibrous and the malignant. The general symptoms of nasal polypus are a feeling of stuffiness in one or both nostrils, inability to breathe down the nose and a thin watery discharge. A nasal tone of voice, together with cough and asthma, may be present, or there may be partial or complete loss of the sense of smell (anosmia). The treatment of mucous polypi is their removal by the forceps or the snare, the base of the growth being afterwards carefully examined and cauterized with the galvano-cautery. Fibrous polypi are usually very vascular, and may be a cause of severe epistaxis as well as of obstruction of breathing, " dead voice," sleepiness and deafness. The increasing growth may lead to expansion of the bridge of the nose and deformity of the facial bones, known as " frog-face." The tendency of fibrous polypi to take on malignant sarcomatous characters is specially noticeable. Extirpation of the growth as soon as its nature is recognized is therefore urgently demanded. The chief diseases of the nasal septum are abscesses, due to the breaking down of haematomata, syphilitic gummata (leading to deep excavation and bony destruction), tuberculous disease in which a small yellowish grey ulcer forms and what is known as perforating ulcer of the septum, which is met with just within the nostril. The latter tends to run a chronic course, and the detachment of one of its crusts may cause epistaxis. Rhinoscleroma was first described by F. Hebra in 187o, and is endemic in Russian Poland, Galicia and Hungary, but is unknown in England, except amongst alien immigrants. The infecting organism is a specific bacillus, and the disease starts as a chronic smooth painless obstruction with the formation of dense plate-like masses of tissue of stony hardness. Treatment other than that of excision of the masses has proved useless, though the recent plan of introduction of the injection of a vaccine of the bacillus may in future modify the progress of the disease. The accessory sinuses of the nose are also prone to disease. The maxillary antrum may become filled with muco-pus, forming an empyema, pus escaping intermittently by way of the nose. The condition causes pain and swelling, and may require the irrigation and drainage of the antrum. The frontal sinuses may become filled with mucous, owing to the swelling of the nasal mucous membraneover the middle turbinated bone, or an acute inflammation may spread to the frontal sinuses, giving rise to an empyema in that locality. There is severe frontal pain, and in some cases a fulness on the forehead over the affected side, the pus often pointing in this site, or there may be a discharge of pus through the nose. The treatment is that of incision and irrigation of the sinus (in some cases scraping out of the sinus) and the re-establishment of communication with the nose, with free drainage. The ethmoidal and sphenoidal sinuses are also frequently the site of empyemata, giving rise to pain in the orbit and the back of the nose, and a discharge into the nasopharynx. In the case of the ethmoidal sinus it may give rise to exophthalmus and to strabismus (squint), with the formation of a tumour at the inner wall of the orbit and fever and delirium at night. In the young the condition may become rapidly fatal. Suppuration in the sphenoidal sinus may lead to blindness from involvement of the sheath of the optic nerve, and dangerous complications such as septic basal meningitis and thrombosis of the cavernous sinus may occur. Acute ethmoiditis and sphenoiditis are serious conditions demanding immediate surgical intervention. (H. L. H.)
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