The use of the new bacteriostatic agents to control infections of the nasal sinuses has been taken up with high hopes by both physician and patient because of the spectacular results obtained by their use for the control of infections in other parts of the body. The physician, in his eagerness to offer something for the treatment of sinus infections that would be better, or at least more rational, than nose drops, oral vaccines, inoculations and short wave diathermy, welcomed the advent of the new drugs with unrestrained enthusiasm. It is now three years since the first favorable report was published on the curing of sinus infections by spraying a solution of a sulfonamide compound into the nose. Rhinologists now should be in a position to take stock and estimate what benefits or damages have resulted from this mode of treatment that three years ago was hailed as a cure for sinus disease.In the approach to the problem of nasal sinus disease, full value must be given to the importance of the common cold, a virus infection, self limited in its duration and recognized by all as a head cold with sneezing, congestion of the nose and excessive secretion of nasal mucus.A bactériologie study will show that in most noses there are present at all times potentially pathogenic bacteria. From the nose of a person in apparent good health there can be recovered streptococci, staphylococci, pneumococci and Haemophilus influenzae along with less common bacteria. Some or many of these organisms are perennial in the nasal cavities of many people. With the invasion of the nose or the nasopharynx by the virus of the common cold, these bacteria at once take on great activity, with increase in numbers and virulence. In the cold sequence this is the important but unexplained phase causing the complications attendant on or following acute coryza. It is probable that the presence of the cold virus in some way activates the normal bacteria of the nose, and with the increase in growth and virulence of these organisms one observes the expected extension of the infection to the nasal sinuses, the middle ear, the bronchial tree or even the blood stream. It is at this point in the progress of the infection that bacteria in great numbers can be recovered from the nose and the nasopharynx. There may be a mixed growth of organisms or, what is more usual, a predomi¬ nant growth of a single type : streptococci, staphylococci or H. influenzae.It is evident that if the common cold or coryza could be prevented or controlled, there would be no succeeding infection of the nasal sinuses by the impotent bacteria that dwell in the nasal cavities. While the cold virus remains unknown, the problem of finding a specific substance to combat it is a difficult one. Since there is no specific treatment for the virus of the common cold, one's effort must be directed against the complicating bacterial infection of those struc¬ tures that are extensions of the nasal cavity. Certain basic principles of treatment will hold good whether the sinus infection is the fulmin...
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