RESPIRATORY PASSAGES, FOR EIGN BODIES IN.
Foreign Bodies in the Nasal Cavities.
Foreign bodies of various kinds may be introduced into the nasal cavities, or concretions may form therein and give rise to the symptoms occasioned by foreign bodies. Again, living organ isms—flies or their ova, maggots, leeches, etc.—may enter the anterior nares and cause stenosis, accompanied by symp toms varying with the nature of the offending structure.
Symptoms.—The symptoms may be subdivided into three classes: (1) those attending the presence of inanimate foreign substances; (2) those caused by concretions formed in the nares: rhino liths or nasal calculi; and (3) those due to the entrance of living structures: flies, their ova, etc.
Various substances—such as buttons, pebbles, coins, fruit-stones, beans, and other dense bodies—may at first give rise to no active manifestations. In the majority of instances there is more or less profuse sero-mucous exudation, fol lowed, if the foreign body causes press ure, by a muco-purulent discharge. The fact that this is unilateral serves to dif ferentiate it from a purely catarrhal dis order in children. The affected side of the nose sometimes projects more than the other. This may occur early, when organic bodies such as peas, beans, etc., are present. These may even germinate in situ. When a history of the penetra tion of a foreign body cannot be ob tained, examination with the probe usually establishes the diagnosis. In adults the only conditions with which confusion could arise are malignant or semimalignant tumors, which are very rare; and syphilis and tuberculosis, dia thetic diseases presenting other char acteristic symptoms.
Concretions formed in the mires, also termed nasal calculi or rhinoliths, gen erally start with an inorganic body as a nucleus, but they may occur without these, through accretion of salts derived from the nasal mucus. Whichever way they originate, they steadily become larger through deposition on their sur faces of these salts,—the phosphate of lime and magnesia, chloride of lime, car bonate of lime, ete.,—and may attain,
though very gradually, sufficiently large size to completely occlude the narium affected. Besides the symptoms caused by inorganic bodies, there may be severe pain, due to pressure and repeated at tacks of epistaxis. The diagnostic feat ures do not differ from those of the form just described, but the probe can usually elicit by the "ring" or grating-sensation conveyed to the hand the character of the occluding substance.
When living organisms—flies, mag gots, etc.—are present, all the symptoms enumerated occur, but they are supple mented by others that become very se vere in advanced cases. If living insects that may have invaded the cavities fully grown, or have developed from ova, are present, they may feed upon the living tissues themselves, causing ulcerative processes. These may not only involve the mucous membrane and the underly ing bone, but the inflammation may ex tend to the meninges and bring on a fatal issue. Severe pain radiating in various directions, formication; a nause ating, purulent, bloody discharge; fre quent attacks of epistaxis, and swelling of the facial tissues are the most evident symptoms present.
Treatment.—Removal is obviously in dicated, but this is not always easily ac complished, especially when the foreign body is imbedded in the tissues or sur rounded by adventitious material, salts, etc. The local use of a 10-per-cent. so lution of cocaine greatly facilitates ex amination with the probe, and under a good light the character of the trouble can usually be determined and the of fending substance withdrawn. The flat end of a probe when curved flatwise is efficient for this purpose when it is pos sible to pass the hooked end either be neath or over the foreign substance. Sinai! polypus-forceps sometimes suf fice. Loose bodies can often be ejected by the use of Politzer's bag in the opposite nostril or by means of sternu tatories.