Hyperplastic Sinopharyngostomatitis: A Manifestation of Borderline Allergy Resulting in Fetor Ex Oris, Snoring and Globus Hystericus

Abstract

In a previous article 1 it was pointed out by Fox and associates that nasal allergic conditions occur which, because of their subclinical character, go unrecognized as of allergic nature. These borderline nasal allergies occur in persons who have or have had other frank allergic manifestations and who come from allergic families. Further, these patients reveal cutaneous sensitivity to particular proteins, especially inhalants, and respond to hyposensitization with these proteins.One of the syndromes described consisted of nasal obstruction, occurring usually on one side or the other, i. e., intumescence, especially bad during sleeping hours, associated with postnasal drip and accumulation of mucus in the pharynx on arising. It was pointed out that the patients had a pharyngeal lymphoid diathesis, diffuse in children and lateral in adults.To this picture we wish to add other symptoms and the oral findings characteristic of these patients, who present a similar type of hyperplastic stomatitis with coating of the tongue and fetor ex oris.Many types of stomatitis have been described by various authors,2 including catarrhal, aphthous, herpetic, ulcerative, gangrenous, mycotic, mercurial and gonorrheal types. The authors cited have stated that the various forms of stoma¬ titis may be the result of many factors working singly or collectively, locally or systemically.These include : lack of oral cleanliness, under-nourishment, acute infections (for example, measles, scarlet fever and diphtheria), irritating chemicals, excessive use of spices and tobacco, gastrointestinal disturbances, carious teeth, poorly made dental restorations, metallic poisons, diabetes, pregnancy, blood dyscrasias and bac¬ terial infections of the mouth, such as those caused by the fusospirochetal organisms.A search of the literature failed to bring to sight a description of the ordinary chronic coat¬ ing of tongue and mouth seen in the person who part of the time or all of the time breathes through the mouth, although Mead, under the heading "Lingua Alba" describes a condition in which the "epithelium and papillae of the tongue become a dull white, but there is no actual fur. It is sometimes associated with chronic intestinal dyspepsia and a bad taste in the mouth preceding the attack." Obviously, this condition resembles the stomatitis associated with nasal allergy.Lain,3 in summarizing oral lesions, mentioned the importance of allergic factors, but he had in mind the oral lesions of contact allergy', that is, ulcération and acute edema caused by dental restorative materials.In the literature on fetor ex oris a proper evaluation of the nasal factor is entirely over¬ looked, the principal emphasis being laid on carious teeth, periodontal pockets and bad dental care. However, this type of stomatitis occurs in all people with nasal allergy and is extremely common. PATHOLOGIC OBSERVATIONSGrossly, the tongue is covered by a yellowish gray coating, which is particularly heavy over the middle and posterior thirds but also is present over the gingival an...