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most certain method of detecting any such likely unnoticed deafness.
In relation to deafness in children it is well to note here that sinus
disease, often overlooked, can be a very potent factor in causing serious
deafness and until the s nus infection is cleared up there will not be any
improvement in the hearing. The last audiometric survey in the schools
in Tottenham and Hornsey has been reported in the Annual Report to
the Committee for 1951.
Nasal Obstructions. A number of children have been seen at the clinics
suffering from nasal obstruction and its wide-spread effects, e.g. mouthbreathing,
sore throats, chest affections, nasal sinus disease, neuroses,
etc. Nasal obstruction is, clinically, a very big subject in itself and can
only be referred to briefly. But it is perhaps the most important defect
we see because of the many and serious consequences which it produces.
A very large number of children suffering from certain forms of nasal
obstruction have been successfully treated at the clinics by Professor
Gautier's (French) method of "diastolization". Diastolization, when
the author's technique is carefully carried out, ranks as one of the most
successful advances in nasal therapeutics in the last 25 years. It is
particularly effective in certain forms of nasal obstruction, such as
hypertrophic rhinitis, and in deafness in children due to lesions in the
naso-pharynx. For many years this has been a standard method of
treatment at our clinics and the results in suitable cases have been
exceptionally good and lasting.
Sinus Infection. This is quite common among children of all ages.
Its recognition is vitally important because it is the primary source of
many other affections, and any treatment for these secondary effects,
not directed to the primary sinus disease, is misdirected therapy and
will end in failure. For the confirmation of the diagnosis and for the
treatment of children with sinus disease, Professor Proetz' method of
"sinus displacement" has been extensively employed; but it is necessary
to emphasise that the technique devised by Proetz must be correctly
used; indeed, if misapplied it can have very serious consequences.
Among the very large number of children who have been treated by
"displacement" very few have been found who did not respond successfully
to this method. Exceptions were the very chronic cases where the
sinuses were seriously affected by profuse purulent suppuration of long
standing. Such cases required operative treatment and were referred
to hospital.
Enlarged Tonsils and Adenoids. On the question of "tonsils and
adenoids" we maintain a conservative outlook towards their removal.
This is a subject of vital importance particularly in the case of children
and it is absolutely essential to be quite clear, clinically, on the significance
of the physiology and pathology of the ring of lymphatic tissue
of which the tonsils and adenoids are part, surrounding and guarding
the entrance to both the chest and alimentary tract. The wholesale
removal of tonsils and adenoids merely on such grounds as "enlarged
tonsils and adenoids," chronic "nasal catarrh", "chronic colds in the
head", "adenoid fades", need only to be mentioned to be rejected.
Lists of rules and indications for the removal of tonsils and adenoids
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