Definition. – A chronic disease, consisting of an extremely hard tubercular new-growth on the skin or about the mucous membrane of the nose, especially the anterior nares.
Symptoms. – Insidious, painless induration and thickening of the mucous membranes of the nasal alae, the septum or the upper lip may be noted. This induration is really composed of the coalescence of circumscribed, hard, dense, flattened nodules or raised plaques. The extension of the process causes the nose to appear broad and flat and may continue to close the orifice to the extent of complete occlusion. Rhinoscleroma is painless, does not ulcerate, and invariably recurs after excision. The skin covering the growth may be normal or hyperemic but the hairs and glands are not discernible. The process may extend to the pharynx, larynx, lachrymal sac, lips, gums, trachea, jaws and soft palate.
Etiology and Pathology. – Both sexes are attacked to an equal extent, usually between the ages of fifteen and forty-five. The disease is more common among the poor and is met with endemically in Austria, Russia, Central America and Brazil. It is extremely rare in our country. A. von Frisch in 1882 reported a bacillus which he described as short, thick, ovoid, non-motile and encapsulated in a colloid substance in series of twos and fours. This special bacillus (bacillus rhinoscleromatis) is believed to be the direct cause of the disease.
Diagnosis. – The situation of the growth in and upon the nose, its slow, painless and progressive growth, stony hardness without any tendency to soften or break down, may easily distinguish rhinoscleroma from sarcoma, epithelioma or syphilitic infiltrations. Where the skin covering the tumor is hyperemic, it may resemble keloid which is rarely seen upon the nose, usually follows a traumatism and present claw-like prolongations. The third stage of rosacea (rhinophyma) presents a soft growth with vascular dilatation, often associated with nodules and pustules. In a doubtful case, a section of the growth can be removed and examined microscopically.
Prognosis and Treatment. – The outlook is unfavorable and the growth usually persists through life, sometimes causing great discomfort from stenosis of the nose, mouth and larynx. Treatment is for the most part unsatisfactory because removal does not prevent return. When obstruction of the nostrils threatens, nasal bougies or sponge tents may be used to keep them open or they may be bored with nitrate of silver sticks. The galvanocautery, electrolysis, X-rays and an autogenous vaccine can be recommended. I have seen reports that indicated that Calcarea phos. and Thuja had been given internally with good results.