I wish to extend my thanks to Drs. E. C. Renaud and Willard Bartlett for valuable assistance in the preparation of this paper; to Dr. Carl Fisch for the pathologic report.
Deady.
Heath, M. D., Charles.—A Case of Sinuses in the Vault of the Naso-pharynx.—The Jour. of Lar., Rhin. and Otol., May, 1900.
Case shown at the Lar. Soc. of London:
A woman, æt. thirty-one years, had suffered several years with discomfort in nose, throat, and mouth, with dyspepsia. Mucosa of nares and pharynx markedly atrophied. Atrophied condition made post-rhinoscopy easy. “The eustachian eminences were seen to be enormous, filling the fossæ of Rosenmüller, and reaching nearly to the pharyngeal roof. Just behind the upper edges of the choanæ, on each side, there appeared a transverse elliptical opening, which was about half an inch long and a fifth of an inch across at the widest part on the left side, and slightly less in each dimension on the right; a probe apparently extends about a quarter of an inch into the cavity.” In the discussion following some thought them to be small recesses formed by cicatricial tissues, other formed by peculiar distribution of adenoid tissue, and still genuine sinuses.
Palmer.
Roughton, B. S. (Lond.), F. R. C. S., Edmund W.—The Diagnosis and Treatment of Chronic Purulent Nasal Discharges.—The Jour. of Lar., Rhin. and Otol., May, 1900.
We ascertain by interrogation, (a) if the discharge is purulent or muco-purulent; (b) whether it is unilateral or bilateral; (c) whether it is continuous, intermittent, or influenced by change of posture; (d) if there is offensive smell perceived by the patient or by others; (e) pain is not usually complained of unless there is obstruction to drainage, and consequently retention of pus under pressure. Unilateral discharge suggests a foreign body in a child or sinus involvement in an adult. If it is intermittent or influenced by position probably originates in a sinus. Subjective fetor suggests sinusitis; while objective fetor, ozena; and combined subjective and objective is the rule in syphilitic necrosis. Location of pain is of very little, if any, use in diagnosis.
Rhinoscopy.—Attention directed to (a) situation of the pus; (b) polypi; (c) atrophy of the mucous membrane; (d) crusts; (e) ulcerations; (f) adenoids; (g) nasal obstruction; (h) foreign bodies. Under (a) beside usual cleansing of nasal cavities and reexamination to ascertain situation, he recommends “tamponading,” i. e., by blocking up first one part, then another, with pledgets of wool, and noticing whence the discharge reappears. (e) Ulceration may be syphilitic, simple, tubercular, or lupoid in origin. “It must not be forgotten that a perforation” of the septum “may be entirely the work of a misused finger-nail.” (g) The normal mucoid discharge damned up by nasal obstruction frequently becomes purulent.
Special methods of diagnosis as follows are mentioned: transillumination; examination of upper teeth; catheterization of the ostium, maxillares, naso-frontal canal, and outlet of the sphenoidal sinuses; external examination of antrum and frontal sinuses; exploratory puncture of the antrum through the inferior meatus, alveolar process, or canine fossa. Diagnosis of ethmoiditis is principally by exclusion.