Ozaena is a term used to indicate an offensive discharge from the nose, depending upon some destructive process in the bones, cartilages, or other tissues. Occasionally authors speak of the condition as a chronic nasal catarrh, but the symptoms will readily show a far more serious and destructive disease. If we consider it a catarrh, a simple chronic inflammation and ulceration will be accepted as the pathology, and many qualifying prefixes will be needed to accurately describe different cases. I prefer, therefore, to consider it a specific form of disease, and originating in a syphilitic, mercurial, or strumous cachexia. As regards the extent to which the destruction may be carried, it will probably be as great in one case an another, but the disease may be properly considered as cured, when disappearing under treatment when of strumous origin, while we otherwise, under the same circumstances, a translation to some other point may be anticipated. Hence, for purposes of prognosis, it will be evident that the diagnosis is a matter of some moment. The first symptoms will usually be an ordinary nasal catarrh, with a discharge of an intolerably offensive odor. As it becomes chronic, the mucous surfaces become inflamed, and thickened until the nares are almost impervious to the air. The discharge varies greatly, in quantity and quality, sometimes profuse, at others almost entirely wanting; the color may be yellow, green or bloody, thick or thin in consistency, but under all circumstances the odor is so offensive; that the patient is an object of disgust to himself and others. Later the mucous membrane becomes destroyed, and the bones are exposed, which, together with the cartilages, are soon broken down and disappear, either by necrosis or caries, or both processes going on together. Frequently the integument is not much, if any affected, apart from a redness or bronzed appearance in the earlier stages, but as the bones and cartilages disappear, the nose falls in, the integument becomes puckered and contracted, and great deformity results.
There is a peculiar form of ulceration of the nose, treated by HELMUTH as something distinct from ozaena, but which I have thought to be a form or modification of that disease. Ulceration commences in the lining membrane of the nares, not preceded by thickening, and very frequently with a slight discharge. Indeed in very many cases there is an absolute dryness of the nose, with difficult detachment of hard, tough scabs or crusts, followed by a sore feeling, and some bleeding. On examining the parts carefully, with the rhinoscope, an ulcer will be found on the septum, which frequently pierces it before any external evidence of disease is seen. From this point the destruction goes on as in other forms of ozaena, and usually extends inwards, involving the palate and maxillary bones. Perhaps this form of the disease will oftener be due to mercurial poisoning then either syphilis or struma.
The treatment must be entirely medicinal, with the exception of the removal of portions of dead bone as they become detached. In the earlier stages the disease may be arrested, if mercurial or strumous, and a cure without deformity result. In the later stages, or when of syphilitic origin, the destruction of tissue will go on in spite of our best efforts, and a cure only be accomplished with great deformity. It makes no difference what treatment is adopted; those who employ local measures do not attain any greater measures of success than others.
Alumina.-Soreness and scabs in the nose, with discharge of thick yellow mucus; swelling and redness of the nose; frequent attacks of coryza. Worse in the afternoon, and on alternate days; while sitting in a room. Better during moderate exercise, and in the open air.
Apis mel. – Inflammation of the nose, externally and internally, with puffy, shining redness, and burning-stinging pain. Worse in the morning, evening, and at night; from heat, especially in the warm room. Better from cold water.
Arsenicum alb.- Swelling of, and burning in the nose; ulcers in the nose; cancer of the nose; profuse, fluent coryza of sharp, burning, excoriating water, with hoarseness and sleeplessness; drawing stitches here and there in the face. Worse at night, also from cold. Better from heat in general.
JOHNSON gives the following case: Sore in the left upper septum, scurfy, large as a sixpence, with inverted edges; thick, horny crust, or scab on the center, of a dirty-yellowish-gray color; sharp burning pains, and itching; worse when touched. Discharge of thin bloody serum, if the scab is removed, with smarting- burning pain when exposed to the air. The case was cured in five weeks.
Aurum fol.-Caries of the nose, with very offensive discharge, and sensitive smell. Exceedingly low-spirited, with suicidal tendency. This is the chief remedy, in mercurial cases, particularly when the nasal disease is secondary upon some osseous disease of near parts. The bones of the skull are painful to the touch, even when lying on a soft pillow, and it is almost impossible to brush the hair, for the same reason. Worse in the morning; also from cold. Better from warmth.
calcarea carbon.-Scrofulous ozaena, with stench before the nose like manure, gunpowder, or putrid eggs. Diminished smell. Worse in the morning and night, also from cold. Better from warmth.
Mercurius.-Red, shining swelling of the nose, with itching; greenish foetid pus is discharged from the nose; swelling of the nasal bones; blackish nose; scurfy nostrils, bleeding when they are cleansed; bleeding of the nose during sleep, or when coughing; profuse fluent coryza, with profuse discharge of watery corrosive mucus; circular performation of the nasal septum. Worse at night; also from warmth, and from the heat of the bed. Better from cold?
NItric ac.-Stitch in the nose; as from splinters, when touching it; the tip of the nose is red, and covered with scurfy vesicles; itching herpes on the wings of the nose; bleeding of the nose, the blood is black and clotted; disagreeable smell in the nose on inhaling air; foetid yellow discharge from the nose; foetid smell from the nose; condylomatous excrescence on the nose; soreness, burning and scurf in the nose; unsuccessful attempt to sneeze; the nose is dry, and stuffed up; complete obstruction of the nose, with dropping out of water; dry coryza, with dryness of the throat and nose, the wings of the nose, inflamed and swollen; fluent coryza, with obstruction of the nose, the mucus is only discharged through the posterior nares; coryza, with dry cough, headache, hoarseness, and stitches in the throat. Worse in the evening, and at night; also on touching the parts. Better on getting warm.