Prostigmine Therapy of Atrophic Rhinitis

Abstract

Recent literature has pointed to new trends in the treatment of atrophic rhinitis. Soskin and Bernheimer 1 have pointed out that the good results reported with the use of estrogenic substances in the treatment of atrophic rhinitis were due to the secondary hyperemia associated with direct nasal application of estrogens. They expressed the belief that the primary hormonal effects were not the essential factor and used prostigmine methylsulfate successfully to produce a prolonged hyperemia in patients with atrophic rhinitis. Whether the pathologic change of atrophic rhinitis is primary, as the so-called ozena, or secondary in type, resulting from infection, the atrophy is dependent on limitation of the blood supply. The other changes, such as mucoid degeneration of the epithelium with later squamification, periglandular lymphocytic infiltration, glandular proliferation and diminution in volume of tissue, are directly and indirectly related to the local changes in blood volume. In ozena the obliterative endarteritis brings these changes, whereas in secondary atrophic rhinitis the inflammatory changes may bring about hyalinization of the walls of the blood vessels, with diminution of blood supply and resultant atrophy.Having observed these pathologic changes, one of us (R. H.) in 1936 began the use of mecholyl in an attempt to stimulate blood supply. Because of the extensive side reactions associated with the use of this drug, such as salivation, tachycardia and flushing, and because the beneficial effects were fleeting, the method was dis¬ carded. However, in 1 case, that of a Mexican girl aged 12, whose entire family had typical primary ozena, excellent results were achieved. At the time it was felt that the lasting results were effected because of the relatively early stage of the disease and the reactivity of a child's tissues.We felt that perhaps prostigmine, a parasympathetic stimulant with more pro¬ longed effects, might give better results. The question always arose as to whether the treatment of atrophie rhinitis resulted in real improvement or merely in greater comfort through rigorous care. In order to measure objective improvement in patients with atrophie rhinitis we decided to study a series of cases under good control in which prostigmine methylsulfate therapy was employed and to use the nasal temperature as an objective measure for determining the effect of treatment. It was felt that with the widening of the nasal chambers present in atrophie rhinitis the temperature in typical cases would be substantially below the normal nasal temperature. We believed also that if therapy aimed at increasing blood supply was effective this would be reflected by an increase in the nasal temperature.From the Illinois Eye and Ear Infirmary.Ampules of prostigmine methylsulfate (1:2,000), 1 cc., were supplied for this study by Hoffmann

REPEATED STELLATE GANGLION BLOCKS IN ATROPHIC RHINITIS (Report of Two Cases)

“…The use of oestrogenic hormones has been advocated (Henner and Busby, 1943;Blaisdell, 1938;Safer, 1942;Greene, 1943;Eagle, Baker and Hamblen, 1939). These substances have also been applied locally with reported benefit (Hall and Macleod, 1942) but they may produce ovarian changes in young females (Guthrie, 1952) and sexual disturbances in the males.…”

“…These substances have also been applied locally with reported benefit (Hall and Macleod, 1942) but they may produce ovarian changes in young females (Guthrie, 1952) and sexual disturbances in the males. A spray of neostigmine methylsulphate has also been used for the relief of odour (Henner and Busby, 1943). Submucous injection of paraffin, first proposed by Lake and Brindel, cannot be generally advised (Thomson and Negus, 1948).…”