Fibrinous Rhinitis

RHINITIS FIBRINOSA, s. membranacea, s. pseudomembranacea, a disease of the mucous membrane of the nasal cavity accompanied by the formation of exudate in the form of films resembling nasal diphtheria. These films have a gelatinous or denser consistency, are white or yellowish-white in color, are difficult to separate from the mucous membrane, and rapidly form again after removal. The disease occurs almost exclusively in childhood, beginning in the posterior sections of the nasal cavity (very often one half of the nose is affected before the other) with a more fluid discharge, which quickly turns into a mucopurulent or purely purulent secretion, sometimes stained with blood. Subjective symptoms are quite varied. More constant are nasal breathing difficulties, heaviness in the head, lack of appetite, and general malaise. The mucous membrane is hyperemic and strongly swollen, and the space between the inferior turbinate and the septum is filled with fibrinous films of the above-described character. R. fibrinosa has the character of a purely local disease and is almost unaccompanied by disorders of the general state, whereas in diphtheria there are severe general symptoms. The disease may last for several weeks without disturbing the general condition of the patient. Bacteriological examination of the nasal mucosal discharge reveals Loeffler's diphtheria bacilli in 80% of cases, which in the majority of cases are characterized by insignificant virulence. In the remaining 20%, purulent microbes are determined: streptococci, staphylococci, and pneumococci. Some authors hold the view that in these latter cases there were also diphtheria bacilli, destroyed by the purulent nasal discharge and the antitoxin of the nasal mucosa. In differential diagnosis between diphtheria primarily developing in the nose and R. fibrinosa, it is necessary to be guided mainly by the general condition: if the latter is good, then apparently one is not dealing with diphtheria. Upon rhinoscopic examination, it is difficult to distinguish R. fibrinosa from true diphtheria. In any case, such forms of rhinitis, when detected, are subject to isolation until bacteriological data are clarified. It should be noted with respect to differential diagnosis that in some cases after chemical or galvanocautic cauterization of the mucous membrane, the same fibrinous films can form as in bacterial R. fibrinosa. In such cases, the anamnesis helps to understand the nature of the disease. - The prognosis for R. fibrinosa is good, since the disease always ends in recovery, although it is sometimes prolonged for several weeks. - Treatment. One should not forcibly remove the films with forceps, as this can cause nosebleeds, and the films reappear very quickly. Usually, they are limited to spraying (several times a day) non-irritating disinfectants (boric acid), and to reduce the swelling of the mucous membrane, a 1% solution of menthol oil or weak solutions of adrenaline are instilled into the nose. Papayotin and pyocyanase preparations are used to dissolve the films. According to some authors, washing or spraying the nasal cavity with a 1-2% solution of silver nitrate and a 3-5% solution of protargol (at short intervals) leads to a cure in a few days. See also Diphtheria, Measles.