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

42                  THE NOSE AND PARANAS AL SINUSES

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SCLEROMA            < s ^.^

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Scleroma is found in certain parts of Eastern Europe, Indonesia and Central

and Southern America, and is due to KJebsiella rhinoscleromatDsis. It consists
of a hard rubbery nodular infiltration of the mucous membrane, reddish-
brown in colour at first, but becoming pale pink later when fibrosis occurs.
There is nasal obstruction, crusted discharge and a slowly progressive, but
painless, stenosis of the nasal cavity. Prolonged antibiotic treatment by
ampicillin, streptomycin or tetracycline may be helpful. Local excision of the
lesions tends to destroy healthy tissue, and stenosis may be treated by
dilatation of the nasal cavities and the insertion of polythene tubes which are
retained for up to 2 months.

LEISHMANIASIS

This condition is rare in Britain, but is met with in Eastern Mediterranean
countries and South America, It begins with an induration of the skin of the
upper lip spreading to the cheek and the nasal vestibule. Later there is an
ulcerated granulating area in the anterior part of the lateral wall and floor of
the nasal cavity to give rise to considerable narrowing of the nose. Similar
granulations may appear on the gums. Histological examination of a piece of
excised tissue will show the Leishman-Donovan bodies. Treatment is by
injections, either intramuscular or intravenous, of organic pentavalent
antimony compounds, or, in resistant cases, of pentamidine.

LEPROSY

Leprosy is due to M. leprae which may invade the nasal mucosa and result in
the destruction of the cartilaginous and bony frameworks of the nose with
consequent collapse. Lepromatous granuloma and ulceration of the mucosa
may be found. The condition is diagnosed from syphilis, tuberculosis and
lupus by histological examination which shows macrophages containing the
acid-fast bacilli. Treatment is by sulphone in increasing doses until a mainten-
ance dose of 100 mg daily is attained, and this must be continued for many
years.