Physiology and functional pathology of the lymphatic system applied to allergy of the nose and paranasal sinuses

Abstract

1. 1. The lymphatic system arises in the phylogenetic scale of life as it becomes necessary to remove from the body substances not readily absorbed by the blood. Its primary function is removal of components of extravascular fluid in the lymph bed. Alterations of this activity, usually produced by some type of lymphatic blockage or lowered tissue pressure, lead to stagnation of fluid in the interstitial tissue spaces. 2. 2. Tissue fluid stagnation in the lymph bed of the mucosa of the paranasal sinuses plays a part in the pathogenesis of allergic sinusitis. 3. 3. Irrigation of the maxillary sinus and fistulization of the sinus mucosa by sinus puncture to relieve trapped tissue fluid are efficient therapeutic measures in severe acute allergic sinusitis. 4. 4. The removal of excess tissue fluid from the edematous mucosa of the maxillary sinus may be accelerated by application of local pressure to the mucosa. The formation of polypi in the middle meatus due to this increased tissue pressure in the mucosa of the maxillary sinus is described. 5. 5. The application of pressure to the edematous mucosa of the maxillary sinus during subacute allergic sinusitis is an aid in relieving some cases of bronchial asthma. The duration of this relief is variable. So far it has continued until the patient is attacked again by an allergen or bacteria. The exact criteria for selecting patients suitable for the application of pressure to their maxillary sinuses are not well established. Apparently pressure should be applied as soon as the definite diagnosis of tissue fluid stagnation in the mucosa is made. Often this is possible long before constitutional symptoms such as bronchial asthma appear. The application of pressure to the mucosa of the maxillary sinus has a good physiologic background. Its therapeutic and practical clinical results can be evaluated better after it has been used more extensively.