EPISTAXIS, FOREIGN BODIES AND PARASITES 33
nasopharynx and recovered from there. The surgeon must be alive to the
possibility that there is a second foreign body present, either in the same side
or in the opposite one, and after removal of the object the nose must be
examined for this.
Rhinoliths are calcareous masses which are occasionally found in the nose.
They may be found in one side only or they may be bilateral. The deposit of
salts, chiefly calcium and magnesium carbonates and phosphates, takes place
around a nucleus which may be organic or inorganic, and the nucleus may be
a foreign body or merely dried secretions of bleed and mucus. Their presence
must be considered in any ^ long-sjanding cases,.QLiiasal. discharge .....
SYMPTOMS. These are nasal obstruction and discharge, but if the rhinoliths
have been present for some time they may give rise to considerable destruction
of the nasal mucosa with the formation of sequestra of cartilage or bone, and
the development of an extremely unpleasant odour. Rhinoliths may attain a
considerable size and are often irregular in shape. The diagnosis is usually
easily made by inspection, but if there is any doubt palpation with a probe
will disclose the rough hard object.
TREATMENT. The treatment is removal under general anaesthesia. The
rhinolith may be too large to remove in a single piece and it may require to be
broken with a strong pair of forceps before removal in fragments. There is a
jnrirrpr the removal and this may require packingjgjth
ribbon gauze for 2-4
FUNGI AND PARASITES
Aspergillus infections of the nose are not common. The symptoms are sneezing,
rhinorrhoea and headache, and the most" important clinical sign is_ th£
dischargeof pieces of tough greenish membrane, which may coexist with
polyprancfgranulatiQn tissue. The fungus can be cultured from this tissue, and
treatment consists in a thorough removal of the fungus.
Khinosporidium seeberi causes a rare parasitic affection which has been
observed among tne natives of southern India, although its distribution is not
limited to that area. The nasal polypi which are formed contain the spores in
all stages of development. Clinically the masses present the appearance of
slender filiforn^ or narrowjeaf-like processes of a dull pink or reddish tint,
with tne surface studded~with many minute pale spots due to the presence of
thesporangia in thejjssue. The growths are friable and bleed readily when
touched, so that they should be examined histologically to exclude malignancy.
Treatment consists in surgical removal of the infected areas..
In hot climates flies may deposit their ova in the nose and maggots result. It
is rare for this to occur in the healthy nose and is more common in patients
suffering from ozaena or syphilis of the nose. Epistaxis, headache, lacrimation
and sneezing develop, and the nasal discharge which is bloodstained at first
soon becomes purulent. Myiasisjmay produce ulceration and destruction of