THE CHRONIC ANTRUM

 Read before I.H.A., Bureau of Surgery, June 27, 1936.

K.A. McLAREN, M.D.

 

It is hard to conceive that the congested mucous membranes in an acute head cold are limited by the anatomical structures of the nasal formation in such a way that those of the nose alone are affected. Surely this condition must extend, to some extent at least, into the various sinuses and air passages which directly empty in the nasal cavity.

Nearly all patients complain of either pain at the root of the nose, pain over one or both eyes, pain in one or both cheeks over the superior maxillary region, or pain in the ears; thus showing involvement of the ethmoidal, frontal, antra or eustachian cavities.

This involvement is more frequently pronounced in one of these regions than in the others. It is probable that the involvement is present in all, but more acute or extensive in a particular region. Nearly all antrum congestions are one-sided.

First in frequency we have the eustachian and middle ear, then the antra, and then the frontal and ethmoid involvement. Undoubtedly, the age of the patient and anatomical development have to do with this election of sites, for eustachian and middle ear conditions are much more prevalent in children than in adults.

Antra and frontal sinus infection do occur in children, but are not recognized by general practitioners, and very infrequently by the nose and throat specialists. In the years I have been in practice, I have seen only two acute antra in children; one was due to scarlet fever, and the other to nasal diphtheria. I have never seen a case following or due to the common cold.

As we grow older the nasal structures grow with the formation of the face, and it is in adult life that we find the antra-ethmoid and frontal sinuses becoming involved from colds. The surgical treatment of these conditions is not rewarded by the brilliant results some times seen in surgery of other parts of the body. All too frequently we are called upon to treat chronic conditions in these parts following surgery. At that, I hold we are more successful in giving relief than the average nose specialist. If we were not, we would not be so frequently consulted.

In the acute antrum what has the surgeon to offer in the way of treatment? First, a combination tablet to relieve pain and bring down the temperature; second, swabbing, the nose with a silver or antiseptic solution, and the use of an ephedrin or adrenalin spray to control the swelling and oedema of the membranes until such time as the patient has established his own immunity to the invading organism, and recovers slowly himself – or does not completely recover and has to submit to drainage and lavage or curettage of the cavity.

We can surely do better work than that with our remedies.

First, we must give the remedy indicated at the time of the onset of the cold. If this is given – and if it is the indicated remedy – there will be no painful inflammation of the sinuses to require further treatment. However, many of these cases do not consult us before sinus involvement, and they appear with the fully developed cold and inflamed sinus at the first consultation. In our northern climate the choice lies nearly always between Mercurius sol. and Belladonna.

The Mercurius patient frequently has a rather foul breath, thick greenish discharge, too much saliva, pain upon blowing the nose and upon swallowing, and perspires too easily. He is flushed and perspiring; but the perspiration is clammy and cool.

The Belladonna case is flushed, eyes are too bright, has severe pain when blowing the nose, on stooping, and from any jar such as misstep. He feels very hot to the touch, and the perspiration is hot. He is chilly, and chilly from moving about even in a warm room, and when undressing.

If seen early, Belladonna is nearly always indicated, and may need to be followed by Mercurius.

Soon after administration of the remedy the pain lessens and the discharge becomes much more free. The nose can be blown without pain, and great quantities of pus-like mucus come from the affected side, and the dull heavy sensation leaves that side of the face.

Now the discharge may die away or change in color to a yellow or bright orange. Here we must change the remedy again. Pulsatilla or Kali bi. or Plantago maj. are the most frequently indicated remedies in this stage, and act quickly and well.

Of course, other remedies may be indicated according to the individuality of the patient, and the part of the country in which he resides. These are often Gelsemium, Nux vomica, Cepa, Arsenicum, Euphrasia, Kali iodide and Kali sulph; and even our old friends Rhus tox. and Eupatorium perfoliatum; but in the main Belladonna and Mercurius will see a great percentage of these sufferers out of the woods in short order.

The chronic cases who consult us, I find are frequently patients suffering from a form of facial neuralgia, and who believe that their antrum or sinus is active again. It is often hard to convince them that the inflammation is in the nerve trunk and not in the sinus. The remainder have a chronic inflammation of the membranes in the sinus and need a course of careful homoeopathic prescribing.

The remedies most often needed for the neuralgia sufferers are Belladonna, spigelia, Gelsemium, Plantago and Rhus tox. Those for the actual chronic sinus are Silicea, Calcarea, Pulsatilla, Kali sulph., Kali iod., Kali bi. and Hepar sulphur. With these remedies, and the cooperation of the patient, no further puncturing or lavage of the sinuses is ever needed.

TORONTO, CANADA.

DISCUSSION.

DR. MOORE: I have the word of one of the best rhinologists in the country, Medhoffer, of Cincinnati, who perhaps has taken care of more noses than anyone, and he says in all cases of acute rhinitis, do not use any wash or any spray of any sort, that they will always make your cases worse.

I rather like the homoeopathic way. I spoke of the case that came in a short time ago, a girl of eight years who came over to my house after I had gone home. Her face was swollen. She had had a cold for six days, and the eye hurt from the beginning of the cold. It was right sided, it was antrum. The teeth hurt. When your antrum is involved, very often the first and second molar will give you some pain. That is one of your sinus signs, although you will get that in the neuralgia, and this brow-ache, which I have cured many, many times with quinine. I am going to try quinine potentized for my next browalgia. I like the idea of taking a remedy that has been used for a curative effect by the old school and seeing if it wont be better potentized. I had a case that wasnt a Belladonna just at the time, but it was a Belladonna two days before. I think that is a real point, Belladonna two days before, and it reacted to Belladonna, and it reacted in twenty-four hours.

DR. MCLAREN: There is a doctor in Philadelphia, I belief, who has made a great name for himself from that method, and one of his student s is now residing in Toronto. The next antrum I have I am going to send to him and see what he can do with it, because I dont want the case operated on if I can help it. Once you have operated on the nose, you are going back.

We used to do some of our empyema drainage with a water siphon that way, put a big five-gallon tank of water up on a stand and then they would put a rubber tube in the mans side and have a wide tube connecting down to the bath tub. Sometimes he would lie on this things, and then the water would run into his chest and all over the bed and everything else. I remember going past the open door of one of wards one time. There was a poor Italian there being drained that way. He said, “Doctar, Doctar, coma quick, coma quick, fixa pipe.” I went in and he was floating round in pus and water.

DR. MOORE: The patient can use that suction. That is something in almost all forms of chronic catarrh. Your patient can do that. It isnt necessary to go to somebody to have treatment. It has been used all over the world. They let the air out and then pull it in as strongly as they can.

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