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Full text of "Diseases Of The Nose Throat And Ear"

EPISTAXIS, FOREIGN BODIES AND PARASITES            31

In severe epistaxis blood should be taken for cross-matching and an
ntravenous drip of saline or packed cells started. Blood transfusion is given
vhen matched blood is available and is continued until the haemoglobin
caches a satisfactory level. Several pints of blood may be required. Should the
>pistaxis not be sufficiently severe to require transfusion, a course of iron
herapy should be ordered until the haemoglobin level is acceptable. Ferrous
.ulphate, ferrous gluconate or ferrous fumarate (Fersamal) are suitable
reparations.

Recurring epistaxes should be treated by cauterization of the bleeding
>oint. In children this is best done under a short general anaesthetic to prevent
;udden movement of the head causing cauterization of the skin of the nostril,
n adults cauterization may be performed after local anaesthesia of the
Bleeding point by the application of a pledget of cotton-wool soaked in 10 per
:ent cocaine hydrochloride or 2 per cent amethocaine solution for 20 minutes,
ji hospital the electric cautery is used with the cautery end at a red heat. If
he end is heated to a bright red or a white heat the vessel may be cut through
ind not sealed. Chemical cauteries are useful in the patient's home, and they
ilso require preliminary cocainization. A fused bead of chromic acid may be
nade by picking up a crystal of chromic acid on the end of a metal probe and
leating the metal in a spirit lamp close to the crystal which melts and fuses
nto a smooth bead. This is effective, covering the vessel with a black eschar
vhich may burn deeply, and consequently a light touch is required. Another
chemical cautery is trichloracetic acid which may be applied, after cocainiza-
ion, on a small wool-tipped probe. Care must be taken not to touch the skin,
vhich causes a smarting, but if this should happen with either chemical an
mmediate antidote is the application of sodium bicarbonate as a thick paste
o the burnt area. The patient, especially if elderly, should rest for 24 hours
ifter cauterization.

Cauterization is not recommended in young children unless there is a
)lood dyscrasia or unless epistaxis has been severe. Many children cause
spistaxis by picking off crusts, and this explains why epistaxis is more often
rilateral than unilateral in children. The application every night of a little
>etroleum jelly into each nostril will soften the crusts or scabs with cessation
>f the bleeding, and in most cases this should be given an extended trial
>efore cautery is advocated.

Very rarely none of these methods will control the bleeding and this is
specially so if the source is in the anterior ethmoidal artery. In such an
svent the artery may have to be exposed in the orbit and ligated.

FOREIGN BODIES

Children, especially young children aged 2 or 3 years, frequently push
breign bodies into the nose. Such objects may be classified as organic and
norganic. Inorganic foreign bodies include metal objects (Fig. 21), buttons,
>eads, plastic objects, etc. These may lie undetected for many weeks, giving
Ise to no symptoms and occasionally are found accidentally during routine
examination. Organic foreign bodies, such as wood, paper, cotton-wool or
bam rubber, produce a local inflammatory reaction which may proceed to the
brmation of granulation tissue. There is a nasal discharge from the affected
ide, and this quickly becomes purulent and foul-smelling, and may be