Acquired malformations of the respiratory passages are common and are the result usually of previous disease or injury. They may assume the obstructive type, as when the tonsils or the other adenoid or lymphoid tissues of the nasopharynx become hypertrophied, or they may assume the constrictive type, as when strictures result from ulceration, produced either by disease or by caustics. Such diseases as diphtheria cause not only paralyses, through the nervous system, but cicatricial deformity in consequence of ulceration. The latter is also true of burns, while fractures may permanently displace parts, this being particularly true of the nose, but holding good also for the hyoid, and even for the larynx. Nearly all these malformations permit of more or less surgical improvement by operations, some of which are simple and easy of performance, while some will need the highest degree of trained skill.
Ozena.
—Ozena is a general term applied to ulcerative lesions, especially involving the Schneiderian membrane in the nose, and causing more or less discharge of mucus, pus, and crusts, nearly always offensive, and accompanied by evidences of deeper ulceration, involving the fragile nasal bones or the nasal septum, and constituting expressions of caries or necrosis in this region. Ozena may be the consequence of a milder catarrhal inflammation, occurring in patients of vitiated constitution and bad habits of life, with insufficient attention or no care whatever. Another type of ozena is from the beginning of syphilitic origin, and it is especially the syphilitic cases which present the most offensive types of lesions, yet which are the most satisfactory to treat, because of the relative certainty with which they yield to properly directed treatment. Any case characterized by profuse and offensive nasal discharge, in which by suitable illumination and examination ulcerations can be detected, should be considered ozena.
Treatment.
—The treatment for all these cases should consist of local cleanliness, alkaline solutions in spray or by irrigation being especially indicated because of their cleansing properties. Warm sterilized salt solution may also be used for the same purpose. All visible ulcerations should be treated by local applications of mild silver nitrate solutions, or some other combined antiseptic and stimulant; or these may be alternated with local applications of an ointment of the yellow oxide of mercury in strength of 0.5 to 1 per cent. Local treatment, however, is but a part of that which should be instituted. In every case where the syphilitic element can be recognized, or where there is good reason for even suspecting it, vigorous antisyphilitic treatment should be begun and prosecuted. While these cases nearly always need one of the iodides, administered internally, there is no way of so quickly bringing them under the desired influence as by inunction with the ordinary mercurial ointment. Both measures should be carried along simultaneously until the combination proves to be too active, when the inunction may be discontinued.
In addition to these measures such cases need improvement of elimination and of nutrition, and the best restorative tonics may be combined to advantage with any other special medication which may seem to be indicated.
FOREIGN BODIES IN THE RESPIRATORY PASSAGES.
Nowhere, except perhaps in the ear, are foreign bodies more likely to find entrance, and become impacted, than in the respiratory passages. They are introduced either through the nose or the mouth. They consist of almost all imaginable substances, introduced either by accident or design, and belonging to all three kingdoms—animal, vegetable, and mineral. According to their nature, size, and lodging place, symptoms of more or less severity will ensue. Migratory bodies, especially small insects and parasites, may escape from the nasal cavity into one of the accessory sinuses, where they will give rise to great irritation, and necessitate perhaps serious measures for relief. The presence of a foreign body is not always promptly recognized. In some instances it is discovered only by accident, as when, having been present for some time, it has produced irritation, with or without ulceration and offensive discharge. Thus a shoe-button may have been pushed up the nose of a little child, and remain there undetected for some time, perhaps to be spontaneously extruded in the act of blowing the nose. The presence of a foreign body in the nasal passages, then, will be manifested by symptoms of obstructed nasal respiration and by other evidences of local irritation, with pain, tenderness, swelling, and discharge.
An object easily seen is ordinarily easily removed, unless it has some peculiar shape which impedes its easy withdrawal. Local cleanliness is the first prerequisite, and then in most instances local anesthesia, which may be produced with cocaine or one of its substitutes. After this a probe, bent into the shape of a blunt hook, or forceps of various patterns and shapes may be required, and will usually suffice for all ordinary cases which can be detected by inspection through the nostrils or with the rhinoscope. In more difficult and unusual cases the fluoroscope or the skiagram may be made to render great service. Should some larger object be found, particularly in the antrum, deeply within the cranium, then a more formal operation will be demanded, whose details should be made to suit the needs of each individual case. When a mass of inspissated secretion or of granulation tissue more or less conceals the outline of the foreign body, everything should be cleaned away with irrigating spray, or with cotton wrapped around a probe or held within the forceps.